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GERSHOM N. BRIGHAM, M.D.,
Grand Rapids, Mieh.
BOERICKE & TAFEL,
NEW YORK : PHILADELPHIA :
145 GRAND STREET. 1011 ARCH STREET.
London : Leath & Ross, 5 Saint Paul Church Yard.
London: Homeopathic Publishing Co., No. 2 Finsbury Circus.
Copyright, Boericke & Tafel, 1882.
Numerous as our treatises upon pulmonary consumption
may be, the appearance of this work needs no apology, pro-
vided the author has something to say. From the homoeo-
pathic standpoint no very exhaustive treatise has yet appeared.
Upon histological and pathological questions, much has been
written of late, and yet the profession have come to no agree-
But it must be admitted that there is quite a change of
opinion going on among leading men of all schools, both as
to the causes of phthisis, and the sources and character of the
morbid products. The controversy between the followers of
Prof. Bennett, who believes the disease to be essentially one of
faulty nutrition, and those of Prof. Virchow, who believes the
disease essentially one of inflammation, is far from being
The more recent doctrines of Prof. Rindfleisch, relegating it
to our class of infectious diseases, does not tend to bring har-
mony of opinion upon the subject.
We have endeavored to present in a succinct manner the
salient points advanced by each of these leading pathologists,
not doubting that there may be much truth in what is ad-
vanced by each of them, but doubting if any one of the above
mentioned writers presents the whole matter included in the
causes and transformations of the lesion known by the general
term of phthisis pulmoualis.
We have thought best to state causes in the ordinary man-
ner of treating this subject, believing a work so handled is
more practical, and that our indications for treatment will be
the better mastered. For it is the successful management of
these cases, after all, which we aim to present.
Without claiming that we have said all, or even the best
that can be said, upon this grave subject, we hope that we have
said enough to stimulate to further investigation in the direc-
tion that we have taken; and that at no remote period, we
shall find means within our grasp to treat effectually the dis-
ease which has so long been an approbrium to the healing art.
If pathology is, to a certain extent, unsettled, and the his-
tology of the disease under review, and possibly the whole
matter in a transition state, we, who study more the inward
expressions of a morbific force acting upon the sentient and
vital forces, can well wait for time to settle these controversies;
while we more especially apply ourselves to the study and ap-
plication of the law of cure, formulated by the founder of
homoeopathy, to determining the best dilutions to use, and the
frequency of their administration.
We do not claim to have added anything to the subject of
physical diagnosis from what may be found in text-books, yet
it is convenient that the matter should appear here.
The author acknowledges himself under obligation to many
of his colleagues who have kindly given him support in pre-
paring this work.
Especially would he mention the late and lamented Dr. Con-
stantine Hering as offering invaluable aid. He is also under
many obligations to Prof. Raue for valuable suggestions, and
to Drs. Hempel and Arndt for cases drawn from their Materia
Medica, and to Dr. Arndt also for valuable clinical translations
from the German; and lastly to the labors of Dr. Dunham.
The author has tried to illustrate in his work, by reporting
clinical cases, the types and phases of disease to which our
different remedial agents seem applicable ; and also to show by
cumulative evidence that phthisis has proved to a certain ex-
fent amenable to remedies.
G. N. B.
This disease is more frequently called pulmonary consumption.
The word phthisis means a wasting away — a slow death. The
use of the term more recently has, by common consent, been
restricted to that species of wasting away which attends the
occupation of the lungs with tuberculous matter and the
changes in its transformation, and the destruction of tissue
where it works. And yet this is a very inadequate definition,
because this local phenomenon must usually be considered
only as a fragment of a constitutional malady ; the focus where
morbid forces concentrate and become expressed in pathologi-
cal changes. That the lungs should become the focus of the
tubercular deposit does not seem strange when we come to
consider that all the blood and blood-making material has a
constant flow into this organ, there to undergo the process of
parting with carbon and of receiving oxygen. The blood fluid
in all stages and conditions of purity, at high grade and low
grade of vitality, passes into this sifting, assimilating and
eliminating organ, to be prepared for the highest uses in the
production of structural formation and for supporting func-
tional activity. That portions of debris should become im-
meshed in this net-work of cells does not seem strange. And
that any such matter should become a source of irritation, pro-
voking a chronic inflammation of the interstitial tissue, would
seem natural enough. Further, that when hyperplasia of the
parent tissue has been developed, pressure upon the vascular
10 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
vessels would follow, cutting off more or less the supply of
blood, possibly" causing exudation from the walls of these vas-
cular vessels and from the lymphatic glands. In defining
pulmonary phthisis, if the lesion be confined to the lungs, as
the term implies, we can correctly speak of pulmonary phthisis
only when the morbid force assails the lungs, and of tubercular
phthisis only when tubercle is deposited.
Again, tubercle has been considered the cause of the phthisis,
whereas it would seem to be a pathological product of a morbid
force working in the system producing this kind of neoplasm,
if it be a growth. It may safely be said that tubercle does not
exist till the morbid force, or disease, is well advanced. It is
uniformly present, however, in pulmonary phthisis of the va-
riety of which we are speaking/ The pathological changes
must be referred to some force affecting the correlating forces
of the human body. And as transformations begin in mole-
cules, no doubt the morbific agent or force is first felt in the
molecular movements. Our understanding of vitality itself
is, that it is a correlating energy — an energy all the time sup-
plied by the transmutation of force ascending from the planes
of the mineral, vegetable, and lower animal kingdom, and that
all force is distributed from molecules. The action, then, of
any specific virus or morbid force as well as the power of a
drug whereby it impresses the organism, is properly spoken of
as a mode of molecular energy. A remedy, if it does anything
to aid vitality in its struggle against opposing forces, does so
by imparting something of its own molecular energy, or by
supporting the molecular or correlating energy or vitality;
more commonly, I think, the first, foods and assimilable sub-
stances usually yielding the last. Indirectly, the drug energy
may do something, yes, much, by removing impediments
which so embarasses vital energy that assimilation, which is
a mode of correlation, is unable to go forward.
Consumption a Curable Disease. — We hold that consump-
tion is not incurable so long as vitality can be made to take a
more self-asserting influence in the tuberculated tissue than
that of degrading chemical forces. Consumption is cured by
aiding nature to convert the albuminous exudation into fat, so
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 11
that it can be absorbed — by controlling inflammation which
leads to the breaking down of structure ; by tubercle becoming
encysted and non-irritating ; by tubercle becoming cretaceous
and no longer subject to softening; lastly, by tubercle soften-
ing and being expectorated through the tubular passages, ab-
scesses and ulcers closing by cicatrization.
It is not an easy disease to cure, and when the graver lesions
are set up, serious doubts of recovery must be entertained. This
may be said of all the graver diseases, that they reach a point
where vitality is so overwhelmed that a majority of cases will
succumb in the struggle.
However, consumption must be classified among our most
fatal diseases. It being usually a slowly developing disease,
the case often gets well along before the attention of the physi-
cian is called to the patient's condition. The opinion, also, of
medical men upon this disease, usually disarms them of all
means to help in the case. Indeed, medical men are very apt
to overlook an incipient phthisis and let it run along well into
the second stage, tubercular stage I mean, before they recog-
nize the true condition of things. This is most unfortunate,
for the successful management of our consumptive cases, de-
pends largely upon early recognition, and prompt attention to
dietary management, good air, proper clothing, possibly change
of climate, and lastly, to efficient medication ; we mean by the
administration of the true homoeopathic agent, and in such
dilution as to call into activity healthy morphic movements
in place of morbid.
The Function of the Lungs. — Have we given sufficient
importance, in the study of caseous accumulations, to the fact
that the lungs receive all the venous blood in the system, to-
gether with the blood-making material from the digestive sys-
tem, in a constantly inflowing stream, performing at the same
time the function of discharging carbons and other matters,
and taking in oxygen ? The double function of elimination
and assimilation being here carried on, it follows that there
must be much debris in a workshop of such activity and ca-
pacity. It is easy to see that very great activity in the clear-
ing away process will be constantly demanded — that any re-
12 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
tarded movement in the drift, tends to load down any portion
of the lung where the movement is slowest ; this would proba-
bly be in the apices where cheesy exudation usually occurs.
Whether a blood-stasis here becomes the iniative step to the
exudative process termed cheesy pneumonia by our German
friends, and caseous exudation by Bennett and his followers,
it may be proper to enquire. Possibly, here may be the ele-
ments of irritation in portions of the lung where such detritus
remains, operating from within the vessels, as the dust of fac-
tories and other work-shops operate without, each provoking a
sufficient amount of inflammation to cause albuminous or fib-
rinous deposit from the vascular vessels. Such detritus might
be compared to the moraines in the drift of a glacier or the
sediment of a river. It is easy to see that any cause operating
to degrade force here would become an active agent in bring-
ing on a tuberculosis ; its might be heredity, scrofula, malaria,
mercury, alcoholism, bad air, excessive venery or any specific
poison. The importance of the function of the lungs and the
amount of matter that must pass into the vessels, small and
great, in these organs is really of a nature to astonish. The
wonder is that they remain healthy so long. To keep them
clear of obstructions must be a very important part of our
treatment of persons becoming enfeebled from any cause.
CAUSES OF PHTHISIS.
First, predisposing causes. In a general way, I think we
may say that any force tending to degrade vital force may be
a cause of tubercular degradation of the elements of nutrition,
and hence a factor in any given case of phthisis. But it may
be accepted that the same force would be active in developing
tubercle in one person and not have any apparent effect in
that direction in another.
Constitutional conditions then play an important part in the
history of tubercle, and, of course, in pulmonary phthisis.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 13
Among these causes we may mention, first, hereditary trans-
mission of impaired vitality. And from this impaired vitality
we get a neoplasm called tubercle. Why this morbific force
expresses itself in tubercular degradation we know not any
more than we know why measles or whooping cough have
their own peculiar workings in the vital economy. It seems
proper to say that we are not able to explain the first cause of
a phthisis coming through heredity, a cachexia, or otherwise,
till investigations are able to eliminate some poison, germ,
force or forces, capable of diverging the lines of morphology,
first, in embryo, and. peradventure through the entire period
of life. It may be that the menace to life comes as much from
conformation, which is largely hereditary, as from a deterior-
ating force which degrades the plasma, or works through nu-
trition, and then nutrition lies behind growth. Most of us
agree that the germs of tubercle, or the conditions favoring
the production of tubercle, are often hereditary. And yet, pos-
sibly, too much stress has been laid upon the hereditary bias.
Again, many regard that phthisis is communicable from con-
tagion or infection. Especially is it believed that a latent tu-
bercular habit is quickened into activity by being associated
with active phthisis in the ulcerative stage. We have had
cases which seemed to support such a theory. These facts
tend to show something specific and of its own kind, in the
morbid force of tubercular phthisis. But phthisis has seemed
almost as clearly to have come from other sources as from this
hereditary element. It can hardly be doubted but that it has
come of other transmitted morbid states, such as, for instance,
arise from alcoholism and syphilis. We have known a family
where both parents lived to an advanced age, dying of old age,
when four out of six of their children died of consumption be-
tween the ages of thirty and fifty, the only cause to be conceived,
being that both parents were intemperate. Then may we not
have a phthisis engrafted upon the constitutional taint of a
syphilis or gonorrhoea? Our predisposing causes are chiefly
the different cachexias. First among these is the scrofulous ;
then follow the syphilitic and sycotic cachexias and alcohol-
ism. Alcoholism, impresses the vitality to a degree to destroy
14 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
largely tlie viability of offspring. I would recognize an alco-
holic cachexia and put it well forward as a predisposing cause,
both in the intemperate themselves and in their children.
Would it not be as proper to speak of scrofula as hereditary,
sycosis, syphilis and alcoholism as hereditary, and phthisis as
a mode of death or advancing degeneration of different morbid
forces with their focus planted in the lung tissue, the early
pathological expression of which is found in tubercle and ca-
seous exudation ? It will be objected, no doubt, that the mor-
bid force which produces tubercle is sui generis and unlike
anything else. Well, we do not know its parentage, if such
an individuality really exists. Reason as we will, we have to
treat certain pathological conditions, and to overcome a morbid
force acting in a very dangerous and pretty uniform way upon
the life forces. Perhaps this method of study will best help in
doing it. We generally speak of scrofula as the root out of
which consumption sprouts. But scrofula is often the offspring
of syphilis, sycosis and alcoholism, to say nothing of bad air,
bad food and many other things which undermine the vital
energies. The rule is, we confess, that specific poisons tend to
propagate their like — syphilis a syphilitic taint, gonorrhoea a
gonorrhoeic, etc. And yet, after a little, these poisons do be-
come changed, and a scrofulous condition is apt to follow. I
think it is pretty safe to say that anything which tends to de-
stroy the- life and coherency of the blood corpuscle, tends also
to phthisis. So that, although every morbific force may have
something of its own kind differing from anything else, yet, as
it carries with it a slow decay, something which deteriorates
the vital force, this molecular death, or corpuscular degrada-
tion, shows itself very commonly in a final relegation to chem-
ical laws in the lungs. To continue our discussion, we will
name a few causes not so remote.
Food. — Improper and insufficient food is no doubt an im-
portant factor in blood degradation, and through this avenue
a cause of phthisis. When, for any length of time, waste ex-
ceeds supply, we may look for pulmonary troubles. Emacia-
tion is one of the first indications of a pulmonary phthisis.
We have noticed that many of the disciples of Dr. Graham die
of consumption. Poor food furnishes only poor blood.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 15
Bad Air. — Living in clamp unwholesome tenements, and
breathing bad air, rapidly deteriorates the blood; and this,
conjoined with bad food, is well known to develop tubercle.
Breathing bad air in badly ventilated rooms and churches,
school houses and factories, has no doubt much to do with the
mortality from consumption.
Malaria. — Malaria being capable of making a permanent
lodgment in the system, may be said to develop something
akin to cachexia. Many cases of phthisis seem to spring up
out of the soil impregnated with malaria.
Exanthemata. — Some of the exanthemata have the power
to degrade vital movements to the extent of preparing the way
for a tubercular deposit. Especially may this be said of
measles and small-pox; and then it holds true of some of the
chronic forms of skin diseases. Perhaps these may as often
be exciting causes as predisposing causes.
Marriage. — Conformation of the chest, as well as high grade
of vitality, are usually derived from ancestry. The narrow
chest can often be obviated by careful conjugal selection.
Menace to life through pulmonary tendencies will be very
sure to follow a marriage where both father and mother are of
consumptive habit. The laws of atavism and variability no-
where need to be more carefully studied than in relation to
the subject under consideration.
Climate. — The last cause which we will mention is climate.
There is little doubt that climate has much to do in forming
physical and mental types of the people living in it.
Conformation, habits and mental and moral peculiarities
largely originate in climate. Even man's food is modified by
it, as well as his dwellings, clothing, and many other essentials
of life. Some have said that consumption was the offspring of
civilization. Dr. Livingstone says that pulmonary consump-
tion scarcely exists among the natives of interior Africa.
This tends to show that living largely in the open air, and
according to primitive customs, obviates tubercular tendencies.
A climate subject to sudden changes, no doubt, is a cause of
congestion of the lung tissues; and this is followed by inflam-
mation, and inflammation is followed by tubercle. Where
16 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
climate has favored the highest civilization, we have the most
consumption. Consumption among civilized communities,
however, is not more in consequence of climatic influences,
than incident to the industries of this civilization.
At the head of these we place dust-particles of various kinds ;
woolen and cotton fabrics, wood and steel furnishing the
largest per cent. Autopsies are beginning to show us how
numerous are lung diseases apparently provoked from what is
breathed into the lungs. The dust which is flying in our
workshops is even worse than the heated air deprived of its
oxygen. All these foreign particles tend to irritate the mucous
membranes and develop an inflammatory condition of a sub-
acute character, which sooner or later, brings on hyperplasia
of the tissue, the next step to cheesy exudation. The mortality
among the operatives in the woolen and cotton mills of New
England goes to confirm our theory. It may be well to inquire
here, if the carpets upon our floors, especially the cheaper and
more loosely-woven grades, should not be condemned on sani-
tary grounds. The amount of dust arising therefrom which
is taken into the lungs is probably much greater than we are
Some of our cases of pneumonitis have their origin in the
irritation caused by foreign substances; that these and pneu-
monias badly managed are at the bottom of much of the con-
sumption in Massachusetts, we think, hardly admits of a doubt.
Inflammation often ends in contraction of the lung tissue, and
contraction favors caseous condensation.
We have known such irritation and chronic inflammation
to follow from the lodgment of a foreign body at the bronchial
bifurcation that pulmonary phthisis followed.
The consumption of needle-grinders is but too well known.
Exhausting Drains upon the System. — These are of the
character of overwork of mind and body; too prolonged lac-
tation; too frequent conceptions; excessive venery, marital,
illicit and solitary. Typhoid fever, caries of the bones and old
abscesses may be added to the list.
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 17
Nervous Shock. — The effects of disappointment, ceaseless
anxiety, remorse of conscience, and inconsolable grief, no doubt
have been the exciting causes to a pulmonary phthisis; who
of us has not seen such victims from cruel and harsh treat-
ments, and from heart-breaking disappointments.
Catarrh. — It hardly need be said that a cold often leads to
a consumption. Very commonly a chronic catarrh produces
hyperplasia of the mucous membranes and of adjacent tissues.
This produces pressure upon the vascular vessels, and cuts off
more or less of the blood supply. In this pathological state
albuminous or fibrinous exudation is apt to follow, giving us
the cheesy deposit. This is thought by many to be a fertile
source of pulmonary phthisis.
Pneumonitis. — Inflammation and occlusion of the alveoli
offer impediments to such supply of air as is necessary to the
changes which must be made to supply the system with good
blood ; it is easy enough to see that we must have here an ex-
citing cause. Improper aeration means bad blood; obstruction
in the capillary vessels means opportunity for the loading
down process from stasis of the blood, and then the sowing of
debris in inactive lung tissue. Inflammation continued means
hyperplasia of the parent tissue, pressure upon the vascular
vessels, and a field favorable for the sowing of tubercle: Fre-
quent pneumonias are apt to end in pulmonary phthisis.
Hsemoptysis. — Haemorrhages of the lungs are often the
first indications of a pulmonary phthisis. They often arise
from tubercular lesions. Again, they occur from other causes,
and tubercle is finally sown in the soil which has come of un-
absorbed matters, injuries to vessels or fracture of tissue, fol-
lowed by interstitial pneumonia ; the end being a consumption.
Yet probably in most of these cases we will find a previous
tendency to morbid action of which the haemoptysis is only a
symptom announcing the danger.
Menstrual Derangements. — The end of a chlorosis, the
dangers of an anaemia, and the troubles which may arise from
a suppression, have long been well understood. It is not too
much to say that a uterine catarrh from its exhausting and
deteriorating effects upon the one hand, and the possibility of
18 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
a metastasis to the lungs on the other hand may become an
exciting cause to a pulmonary attack with tubercle associated.
Some of these causes will be considered more in detail here-
To conclude this part of our discussion, we say, then, that
the causes of phthisis are various. It may spring out Of a root
so permanently planted in the organism as to be transmissable
by hereditary laws. It may arise from cachexias that under-
mine the system and form a soil for the sowing of tubercle. It
may arise from accidental causes, no previous taint having
affected the system.
In other words phthisis may be constitutional and heredi-
tary, or accidental. Accidental phthisis, once developed, no
doubt, often becomes transmissable, and tends to permanency
in structural transformations.
The decrease of red blood corpuscles and increase of the
white corpuscles may have much to do with the caseous exuda-
tion; the white corpuscles are composed chiefly of albumen,
and the fact that they fail to become red corpuscles, or that a
red corpuscle loses the coloring matter, indicates an arrest in
the advance of albumen toward a state favorable to healthy
tissue -transformation. In other words, when it leaves the
blood-vessels it is in a condition of low vitality, with a tend-
ency to retrogarding transformations, such as to fatty degene-
ration, salts of soda and lime, which are the constituents of
tubercle. May we not properly call this condition a hyper-
albuminosis or hyper - fibrinosis of the blood; the cause trace-
able to faults of secondary assimilation? This diathesis is
often called strumous, because of the tendency to glandular
enlargement; what particular function the glands may have
in elevating albumen to structural fitness may be a question;
but the tendency of the glands to hypertrophy and to take on
inflammatory action in leukaemia is fully admitted. Whether
tubercular infiltration is the product of a lymphangitis may
be a question for pathologists to settle hereafter. It was claimed
at one time that the matter called tubercle was no more nor
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 19
less than white corpuscle extravasated into the tissues. It is
held still, that tubercle is exudative matter of an albuminous
character, thrown out from the vessels as tissue -matter with a
low grade of vitality, and hence with a tendency to degrada-
tion to a lower plane, such as earthy matters and fat. It is
pretty generally agreed that red corpuscles become diminished
in connection with tubercular deposit ; and as this expresses a
low grade of vitality, it favors exudation. It may be a question,
however, if this be not one of the primary pathological changes,
and more of a symptom than an element of causation. If so,
we would still have to go behind for the element, or elements of
causation. Further, it may yet be considered debatable ground
as to whether tubercle is deposited from vessels which carry
structure -building material forward for tissue alliance, which
alliance fails because the material is of too low vitality, or
whether after all it is deposited from vessels conveying from
the system rejected matter, moving under chemical law, which
in the form of excreta, in one way and another, is drifting to
a lower plane, and tends to move out of the system. It is claimed
by as respectable authority as Dr. Prout that a tendency to
assume the crystalline form, is evidence of matter being of the
character of excreta, which must be rejected from the system.
It is conceded by all, that the lungs are one of the emunc-
tories, and carry large quantities of rejected matter from the
There is no doubt but that tubercle takes the chemical di-
rection in transformation and tends to enter into the crystalline
form. Whether our opinions are to undergo any change here-
after, remains to be seen. That tubercle once deposited must
be treated as a foreign substance needing to be absorbed and
thrown out of the system as excreta is very clear; nor do I
think that we can successfully contend against the position
that tubercular deposit is a pathological product.
20 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
THEORETICAL OPINIONS UPON TUBERCLE.
Two theories upon the histology and pathology of tubercle
prevail; one of the English and one of the German school of
pathologists. Professor Hughes Bennett may be said to head
the English school, and Flint and Reynolds adopt his opinions
into their text-books.
This theory holds that the tubercular exudation comes of a
low form of histo-genesis, originating out of some dyscrasia
that deteriorates the blood, and that the cheesy tuberculous
matter is thrown out from vascular vessels into the interstices
of the parent tissue, where it undergoes transformation. We
quote the Professor's own words: "With regard to its mode of
production, tubercular matter is first separated from the blood-
vessels as a fluid exudation, forming by its first coagulation a
molecular blastema. The molecules of which it is composed
then aggregate or melt into each other to produce the tuber-
cular corpuscles. These, if compressed together and formed
slowly, constitute the dense granulations described by Bayle ;
but, if separated by soft molecular tissue, produce the more
common yellow tubercles."
The other theory, which is championed by Virchow, and
adopted in Niemeyer's Theory and Practice, regards tubercle
as a new growth and as the outcome of cell-proliferation.
Reginald Southey presents the following doctrines as express-
ing the views of German histologists :
"Tubercle is a new growth belonging to the lymph tumors,
constructed after the pattern of lymph glands, and standing
in closest relation to connective tissue formations. The single
tubercular, or tuberculous tumor, is not capable of identifica-
tion from any one element entering into its composition ; but
its origin, its development, and its minute structure, together
confer a particular stamp upon it as a whole, which renders it
capable of distinct recognition. The tubercle formation is cell-
structured from the moment of its first appearance; it proceeds
always out of connective tissue, or from some tissue closely
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 21
allied to this, such as false membrane, fat, or the medullary
tissue of bone. It exists in two forms, the one the cellular, the
other the fibrous form ; but they have such features in common
as imply unmistakable oneness. The fibrous form is only a
slight structural modification of the simple cellular— a modi-
fication impressed upon it by the external conditions of growth.
The origin and mode of development of the simple cellular
form is best of all to be studied from the tuberculous growth,
as this is found upon serous membranes, or upon the mucous
membrane of the larynx. This young growth here is smaller
than a millet seed; has a granular look, and contains soft, im-
perfectly developed cells, which are easily broken down, and
also free nuclei. Its elements are identical with those that
constitute a normal lymph gland, although differently grouped.
This isolated tubercle forms the tiniest tumor that occurs on
the human body, but it is rarely, if ever, single. These growths
are found in nest-like groups, close together, and multitudes
of nodules, originally and individually distinct, combine to-
gether and form a conglomerate tumor." Caseous or cheesy
exudations, which are believed to be usually the result of
chronic catarrh, are spoken of as gland tumors of a scrofulous
nature, or the outcome of scrofulous hepatization of the lungs,
which is thought to be distinct from the tubercular neoplasm.
Dr. Southey goes on to say: "The catarrhal process extends
into the air-cells, the appearances finally obtained being
scarcely distinguished from those which attend acute pneumo-
nia; catarrhal mucus cells and fibro-plastic ovoid nuclei are
mixed together and block up the alveoli; the inter-vascular
spaces are trebled in thickness (" hyperplasia "), and come to
present a dense and more or less fibrillated connective tissue."
The disciples of Virchow thus make a distinction between
what they call caseous pneumonia, and the tubercle found
upon serous and mucous surfaces.
The caseous exudation, so often found in the apices of the
lungs, they speak of as a mucous cast of an air-sac; and the
diseased action by the term caseous pneumonia, reserving for
the diffuse, millet-sized neoplasm the term tubercle. And
yet, consenting and affirming that the adventitious product
22 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
called caseous exudation or mucous cast, produces in softening,
cavities and destruction of the lung. They say: "It is an ad-
ventitious product; it is the result of a local inflammatory pro-
cess, true enough. It is deposited from the blood, and coagu-
lates in the part where it is found; softens into a cheesy mass
from the center. It almost plugs up the smaller bronchi ;
death follows from pressure and cutting off nutritive supplies."
Now there is much to be said in favor of making a distinc-
tion between pulmonary phthisis developing out of inflamma-
tory action, such as a catarrh, a pneumonia, and the irritations
arising from dust of one kind and another, as well as other
accidental causes, and the disease known as scrofulous pulmo-
nary phthisis, or the phthisis arising from faults of nutrition,
as the English school would make all cases of phthisis to arise.
Much stress is laid upon this histological and pathological
disagreement of the two schools by James Henry Bennett,
bearing upon the treatment of phthisis. One believing the
disease to arise from defective nutrition, from which we get a
low form of histo-genesis represented in these coagulated ex-
udations from the blood, while the other considers them new
growths of a fibrous or cellular form, developed out of the con-
nective tissue, and resulting from irritation and inflammation
largely, it follows that the treatment is likely to be very un-
like. This, indeed, has much significance from an old school
stand-point, but it will not be likely to trouble the homoeo-
path much, as he is to give the similissimum in any event.
The histology of tubercle, then, is hardly a settled question.
And for the present work, we, with the French physicians,
shall accept both theories in part, not admitting that either
party, or both parties combined, have yet learned, pathologi-
cally and histologically, all that is to be learned of the disease
known as pulmonary phthisis.
Hitchman affirms that consumption is primarily a disease
of the nervous system: "A derangement par excellence of the
nerve globules;" the steps in tuberculosis proceeding in indi-
gestion, and consequent mal-assimilation of the food and im -
poverishment of the blood, accompanied with an excess of
acidity in the alimentary canal, the final fact being tubercular
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 23
deposit. Now, this seems to me to be as far from answering
the question as any other theory advanced. It may be doubted
if nerve-waste be any earlier involved in the retrograde meta-
morphosis than some other of the tissue elements. Albumen
is found in exceptional proportions in the composition of nerve
globules; and this being the fact, it is not easy to see why
that particular structure should be the first to suffer, with this
excess of fibrin or albuminoid matters flowing all the time in
the blood to the brain.
It may be said that it does not come in a condition to be
correlated, or allied, with structure. If that be the fact, it goes
far to prove that we must go behind this hypothesis for the
Though pathology, so far as it affects treatment, is of less
importance to a homoeopath than an allopath, yet it might
modify both his treatment and prognosis, if he should decide
that a phthisis began as a lymphangitis, and from it we had
hyperplasia of the connective tissue the same as we get hyper-
plasia in other organs where the inflammation extends from
the mucus membranes to the parent tissue or to fibrinous struc-
tures. Hyperplasia of the parent tissue really seems to be one
of the early pathological changes in tubercular phthisis. It is
prepared ground for the sowing of tubercle. A lymphangitis,
or even a hyperplasia of the areola tissue would be held by
most of our physicians, no doubt, to be curable; the diathesis
in a pulmonary lymphangitis to be considered, as in treating
a disease of the kind elsewhere located. The hereditary fea-
ture of the disease, should not preoccupy our minds to such an
extent as to have us yield our ground without a battle.
With our homoeopathic remedies we may expect to neutral-
ize even the hereditary element, in some sense. Admitting
this disease to be of a nature subtle enough to work among
the molecules, and to degrade protoplasm, we have agents as
subtle in our list of potentized drugs. Recognize the morbid
force as something working against vitality, something arrest-
ing and degrading the correlating energy within, which we
will term organic correlating force, or life force, and we, above
all physicians, are prepared to grapple with this something
24 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
which so successfully eludes the scalpel and the microscope.
We have the language of the mind and the entire nervous
centers, as well as every objective symptom, to guide us to the
character and seat of our enemy.
REVIEW OF PATHOLOGICAL AND HISTOLOGICAL
That a majority of our cases of consumption are not the re-
sult of neoplasm (tubercle), but of inflammation, as Virchow
says, such authors as Niemeyer, Guttman and others agree to,
and the French pathologists seem to lean that way. This is
Niemeyer 's language : " The knowledge that a majority of cases
of consumption are not the result of neoplasm, but inflamma-
tion, and that when tubercles exist in phthisical lungs, the
tuberculosis is almost always preceded by a pneumonic process,
which, by caseous degeneration of its products, has prepared
the soil for the growth of tubercle, has been of material assist-
ance in explaining the etiology of consumption. Numerous
well established facts, which had hitherto defied all interpre-
tation (as long as consumption was always a neoplasm), are
now fully reconcilable to the generally acknowledged laws of
pathology. Predisposition to pulmonary consumption, or to
speak more precisely, the predisposition toward pneumonia
terminating in cheesy infiltration, is strongest in persons of
feeble and delicate constitution."
After saying that croupal pneumonia, whooping cough and
measles, may all end in caseous infiltration, that delicate and
ill-nourished subjects have a peculiar liability to pneumonia,
that the inflammatory derangements of nutrition occurring
under such conditions give rise to a profuse formation of young
and indeterminate cells which are of a perishable nature, he
adds: "The main points of the subject may be summed up as
follows : The consolidation and destruction of the lungs, which
form the anatomical basis for consumption, are usually the
products of inflammatory action, and the greater the quantity
of cellular elements collected in the vesicles, and the longer
the duration of inflammation, so much the more readily will
pneumonia lead to consumption, since these are the conditions
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 25
most favorable for trie production of caseous infiltration. Sec-
ondly, pneumonia resulting in caseous infiltration occurs most
frequently, but not exclusively, in puny, badly nourished sub-
jects. This is partially because all inflammatory nutritive
disorders by which they may be affected show a tendency to
copious cell formation, with subsequent caseous degeneration."
The scrofulous diathesis he makes to be a tendency to hy-
perplasia of the lymphatic glands with profuse cell prolifera-
tion. This brings us nearly to the point where tubercular
exudation should properly be called the product of lymphan-
gitis, phthisis a glandular hyperplasia with exudation into
the connective tissue. The tubercular phthisis of Virchow
would seem to be a disease of the glands, and caseous pneu-
monia the real disease of which our pulmonary patients
This view has the merit of simplicity of statement, and
there are many analogies to support the theory.
The question whether consumption comes from inflamma-
tory action, as Niemeyer and Virchow affirm, or from the
non-inflammatory (are we sure that ansemia is opposed to
inflammation?), as John Hughes Bennett and others affirm,
does not so much concern the homoeopath to know, for his
treatment will ever be to meet the law of cure; his remedy
coming through the pathogenesy of the drug; and this he will
support by hygienic measures. Perhaps his cases will be
more intelligently studied if the inflammatory or non-inflam-
matory theory can be settled, and yet it is hardly to be made
a vital issue. If his case come to him with a dyscrasia, he
should recognize and treat it as an all-important modifying
cause, be it what it may.
That we often have to go behind all facts which pathological
study reveals to the vital force itself, and to primary molecular
movements to find causes, seems to us well settled.
,The Why? is not to be answered as yet; not even Where?
and When? the first divergence from progressive morphology
begins. We are of the opinion that we should keep pneumo-
nia distinct in our nomenclature of diseases from tubercular
phthisis. We do not believe pneumonia to be a hereditary
26 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
disease, but the scrofulous or tubercular diathesis we do believe
to be hereditary, and with it phthisis pulmonalis of the scrofu-
lous type. We do not believe pneumonia to be a contagious
disease, nor that it has any germ by which a woman bearing
children from a husband affected with pneumonitis, even if he
have hepatization, can be inoculated with the germs of the
disease; and yet we hold that tubercular phthisis can be
transmitted in both of these ways, that is, by child-bearing
and by infection from sputa. Nevertheless, we do believe that
we may have pneumonitis, degenerating into a pathological
condition which yields the cheesy product, and out of it will
open up fatal cavities in the lungs, tubercle being a concomi-
tant. It becomes a phthisis in final transformation and deg-
radation of the adventitious matter, though probably lacking
the element of propagation, so far as the pneumonitis is con-
cerned, at least.
We have no hesitation in saying that a large per cent, of
our fatal cases dying of what is called consumption begin in
pneumonia, or chronic catarrh. Such cases come to us from
our factories, our coal workers, stone-cutters, needle-grinders
and other occupations; of inflammations from irritating sub-
stances carried upon the lungs in respiration, the inflammation
ending in thickening the connective or areolar tissue, and de-
veloping a fibrinous mass which is the best of soil for tubercle
if not the chief and only cause of tubercle. Consumption is
also the result, oftentimes, of a prolonged catarrhal inflamma-
tion of the bronchi, when it is doubtful if tubercle be present
at all. Perhaps we more often have bronchial dilatation and
bronchiectatic cavities which become reservoirs for secretions
to undergo purulent changes; and a bronchiectasis is only a
little less grave than a cavity following tuberculous infiltration.
That we should give most important heed to catarrhs and
pneumonias, as sources of fatal troubles of a pulmonary char-
acter, seems to me no one can question. Especially should
one be on the alert for an attack of chronic interstitial pneu-
monia if the gravest termination of our cases is to be avoided.
Call this pathological condition pulmonary phthisis, if it will
provoke any more energy in treatment. It, at least, is an
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 27
almost universal concomitant. Then, again, we cannot too
strongly emphasize the dangers which arise from any cause
which tends to provoke an ansemic state and derange the pro-
gressive morphic movements; such as onanism, venereal ex-
cesses, intemperance, immoderate study, too severe an applica-
tion to business, excessive lactation, drains from leucorrhceas,
etc.; for it is idle to say that consumption, as it is understood
by a majority of the profession and people, does not come of
each and all of these causes, and, so far as we can judge,
independent of hereditary bias. Then, claiming, as we do,
something individual, and of its own kind, for ' scrofulous or
hereditary tubercular phthisis, nevertheless, there come to us
from many causes, cases which are attended with caseous de-
generation, going through with all the stages of transformation
which attend tubercle associated with the scrofulous diathesis.
INFECTION AS THE SOURCE OF TUBERCULAR
The theory of Professor Rindfleisch, of Wurzburg, Germany,
that tuberculosis is essentially an infection-disease, is not alto-
gether unworthy of our consideration. Rindfleisch bases his
theory largely upon the fact that numerous experiments by
vaccination with the tubercle-virus taken from the human
species works upon animals, and he accounts for the fact that
it does not take in a large per cent, of the genus homo, claiming
from this, the latter have obtained immunity by quasi habi-
tuation. These are his words :
" Originally tuberculosis probably was a similar infection-
disease as we find syphilis to day. Perhaps it was more viru-
lent. It possessed, and possesses even now, the faculty of being
transmitted from parents to children. By such transmission
the tubercle- virus became more and more diluted, but at the
same time it gradually became the property of mankind, and
thus by its heredity acquired a certain immunity to outside
infection." There is no doubt but that there is an element of
infection at certain stages of tuberculosis, but whether the in-
fective power is gained by transformation of the elements or
be an anterior fact, may be a question. Is infection a proper
28 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
term to apply to hereditary transmission? He goes on to say:
" Tuberculosis shows itself in that peculiar course, taken by
certain inflammatory processes, produced by moderate stimuli."
"A tubercular inflammation may be considered:
1. "The disseminate miliary tuberculosis; where we find in
most organs of the body miliary and submiliary nodules. It
is the typical eruptive form of an infectious general disease,
similar to the efflorescence of pustules in variola.
2. "A more localized miliary tuberculosis; where a solitary
organ remains the chief seat of the eruption, and of the accom-
panying inflammation, whereas all other organs are relatively
3. " It may also be considered as localized miliary tubercu-
losis: where around an inflamed spot of the organ we meet
more or less miliary tubercles, they finally enter themselves
into the composition of the. inflammatory focus, and eventually
form the great mass of the entire infiltration. Genuine phthisis
4. "Inflammatory processes, especially ulcerations of a slow
course with a decided tendency to intervals of rest, or with a
total cure, where we have no, or barely any, local development
of miliary tubercles, but nearly without exception tuberculosis
of the lymph-glands. Chronic caseous and scrofulous inflamma-
"All such manifestations of tuberculosis must be considered
as inflammations, whereby the tubercle-poison acts either as
the sole inflammatory stimulus, or where it, in connection with
other stimuli, especially mechanical, causes a local inflamma-
tion, such being localized tuberculosis. Considering the part
which the miliary tubercle plays in the inflammatory processes,
we naturally surmise that we possess in it a real specific pro-
duct of tuberculosis; where the tuberculosis appears without
admixture, and where it presents itself as the first and sole
manifestation of an infection with tubercle-poison, we always
meet it in this form."
We get the idea from reading the professor's article, that he
would regard the entire race either as having nearly worn out
the tubercle-virus, or carrying in them the infection, only
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 29
latent because no adequate stimulus has yet provoked it into
activity. Persons are only immure, after all, by keeping up a
good nutrition and a good quality of blood. A strong point
of danger, the professor thinks, is from auto'-infection, and we
must admit the full force of such danger, especially as bearing
upon pharyngeal, laryngeal and broncho-tracheal complica-
tions. No doubt tubercle multiplies by infection even in the
lungs and mesenteric glands. It is satisfactorily proven that
the human species can be inoculated from the tuberculosis of
the bovine species, but it does not seem to be histologically the
identical disease known as tuberculosis in the human species.
Whether it be the original from which human tuberculosis is
descended, may form the subject of an important enquiry; it
is very fatal and rapid in its course. The question, whether,
or not, tubercular phthisis is essentially an infectious disease,
must at least be considered open for further investigation.
I am pretty sure that we have cases of phthisis from the
effects of alcoholism, and from other causes not infectious.
Alcoholism operates to work a slow death of the spermatozoa,
and anything which tends to destroy life in the germinal state
tends to develop a phthisis in the end, and the lungs more
than any other organ, will be the seat of such morbid changes.
Some have broached the theory that spermatozoids are only
leucocytes or parent cells; that really this necrosis begins with
the decay of parent cells or leucocytes; and this is getting
pretty near to primary work.
Evidences seem to prove that phthisis pulmonalis is a disease
of civilization, and of more recent origin than the theory put
forward by Professor Rindfleish would indicate. Livingstone
states that the natives of Africa know nothing about the dis-
ease. It must be remembered that the theory of infection is
gaining ground as applied to very many diseases at this time.
Chicken cholera, diphtheria, glanders and other diseases, are
proved to be infectious. The infection does not often go to the
extent of being reproduced in offspring however.
In bringing under the tuberculous habit the processes of
cheesification, the formation of atonic ulcers, and other morbid
forms akin to these, by which the phenomena of the morbific
30 PHTHISIS PULMONALIS I TUBERCULAR PHTHISIS.
force becomes widened, is, we are inclined to think, sound rea-
soning. On the whole, Professor Rindfleisch has done the
profession good service in calling their attention to this sub-
ject, and it may help us to a more thorough knowledge of this
When our catarrhs, pneumonias and malarias run on into a
phthisis, he would have it that they provoked an inflammatory
action, which awakened the tubercle-virus in a constitution
Heubner, of Leipzig, in speaking of phthisis of the respira-
tory organs, says : " It may appear difficult to extirpate rooted
ideas on a disease of daily occurrence, but the doctrine of the
infectiousness of tuberculosis clears the way to the understand-
ing of a unity of tuberculosis. All manifestations found in
the respiratory organs in phthisis can be derivated from one
cause, the tubercular poison, whether it be a catarrh of the
apices, a cheesy infiltration, a hsemoptoe or a phthisis origin-
ating in a pleurisy. We deal therefore with an infectious dis-
ease, produced everywhere by the same poison. Thus we un-
derstand many a thing in the semiology of phthisis, which
was formerly not clear." To what extent this theory of propa-
gation by infection will be accepted by the profession, time
will tell. There is a tendency to increase the number of our
infectious diseases. Life is propagative and death is propaga-
tive and alliances are with likes. Like begets like. The retro-
grade metamorphosis once having set in, it has a tendency to
carr} T molecular movements in that direction. If the transfor-
mation become rapid, we say it is virulent. And like the
leaven in yeast, the fermentation goes on about its work, and
the greater the activity the greater the power to engraft and
propagate. Whether phthisis is infectious until the stage of
active transformation of tissue sets in, may be gravely ques-
tioned. Even small-pox is not infectious until the pustules
fill, nor diphtheria until chemical action in the exudation
This theorj 7, no doubt is partly true, and how much it will aid
us in arriving at a more complete knowledge of this disease,
and how far it will aid us in arresting its ravages, remains to
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 31
be seen. It is well said by these gentlemen that our first duty
is to destroy this poison if it be infectious. But as that does
not appear to be practical, the next thing to do is to increase
the power of the race collectively, and in the individual, to
resist the action of the virus. I have no doubt but that
phthisis has been propagated from one person to another in
the same family, through the medium of the sputum, and by
the breath when active ulceration was going on. Persons
with an hereditary predisposition would be more liable to
danger. In the case of man and wife I have seen phthisis
apparently communicate where there was no predisposition.
The following is admirable: "Where the poison has affected
an individual, our treatment must be more directed toward
the whole organism, as thus only we diminish his disposition
to disease, facilitate the encysting or excretion of the poison,
and thus prevent auto-infection die novo, to which the patient,
even with a solitary tuberculous focus, is exposed."
Hereditary transmission is generally believed to be by far
the most prolific cause of phthisis ; it is not in conformation
alone but in diathesis or hereditary cachexia that it propa-
gates, or as just stated by infection. There is no doubt but
that nature tends to perpetuate types and peculiarities; no
doubt but that the expression of vitality, even in the germ, is
very variable. In fact, there is no doubt about the transmis-
sion of disease from parent to child, by hereditary laws. This
element of disease may come in, I believe, with immediate
ancestors, or it may be propagated from generation to genera-
tion ; rheumatism, syphilis and tubercle are instances. I must
affirm my belief that tubercle may come in accidentally, and
afterward become a permanent cachexia, handed from genera-
tion to generation, unless eradicated by potential measures.
To do this, it must carry the power of modifying cell-life.
This morbific force being engrafted into the cell-nuclei is a
degrading energy and a propagating energy, from the parent
cells, out of which morphological movements begin. I do not
see any objection to naming this unknown morbific force,
tubercle-virus, as Professor Rindfleisch would have us.
But is that a bar to the theory, that the poison may be gen-
32 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
erated by some process of transformation which is set up re-
cently, and may be produced at any time, conditions favoring,
independent of a virus carried in an ancestor, and by the
whole family of man in a state of quasi habituation? In other
words, if tubercle-virus may not be of spontaneous generation?
It is doubtful indeed, if the morbific force be identical in all
cases of phthisis pulmonalis. And yet it may be, as what
seems exceptional may be undergoing such modifications as
incidental influences are responsible for.
A bovine phthisis pulmonalis is believed to be distinct from
phthisis originating primarily from human sources. It has
many close resemblances in its workings, and only for its
rapidity and complications could hardly have any histological
difference. The tubercular transformation is the same. The
course of acute miliary tuberculosis and the course of bovine
tuberculosis are quite as much alike as the course of acute
tuberculosis and the course of chronic tuberculosis or caseous
exudation. It may be as true to say that they belong to a
family, as that they are identical.
The spontaneous generation of infectious diseases seems to be
pretty well settled. Scarlatina, diphtheria, cholera and other
contagious and infectious diseases, are supposed to be generated
from chemical changes of excreta and transformations occur-
ring in connection with degrading molecular movements.
Why may not tubercle-virus originate in a similar way?
Plastic exudations follow in the course of the development of
some of these diseases. If the virus of any of these diseases is
thoroughly eliminated, it is not transmitted ; if it becomes a
constitutional taint, it is transmitted by cell degradation.
The earliest tendency of tubercle seems to be to undergo
fatty transformation, in which condition it becomes easily
absorbed ; caseous degeneration is probably only at a little re-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. S3
move from fatty degeneration ; perhaps as much a product of
an imperfect effort of nature to fatty transformation, as any-
thing. The structure of tubercle is modified by the time it
has been deposited ; it varies in consistence from soft to hard.
Soft, cheesy tubercle, studied with the microscope by mixing a
little with water and breaking it down, presents to the eye a
number of irregular bodies with numerous molecules. To
these molecules pathologists have given the name of tubercle
corpuscles ; they are of a rounded, irregular form, and meas-
ure from the yoVo" to 40V0 °f an inch. They are distinct in
outlines and with a very high magnifying power are seen to
have in their walls smaller bodies which are called granules.
Albumen, fat and minerals seem to be constituents of tubercle,
albumen chiefly at first. The softer the tubercle, the more
readily detected the granules, and the more abundant they
seem to be. In hard tubercle the granules are very indistinct;
again, the more plastic and fluent the tubercular substance,
the greater the proportion of corpuscular or molecular ele-
ment ; and, again, the more chronic and cretaceous the tuber-
cular elements, the more are they transformed into gritty par-
ticles, which chemistry shows to be earthy salts. Cretaceous
or hardened tubercle varies very considerably in size and
Tubercle, as an unchanged exudation matter, is acted upon
by acetic acid to a small degree; the corpuscles are dissolved
by ammonia and liquor of potassa, but are not affected by
ether or alcohol to any noticeable extent.
By chemical analysis, tubercle is proven, then, to consist of
animal matter mixed with certain earthy salts, and the relative
proportion of these constituents varies in different specimens
of tubercle; the animal matter being more abundant in newly
deposited tubercle, and the earthy matter the more abundant
in chronic tubercular deposit. Analysis further shows, that
the animal matter is chiefly albumen with a trace of fibrin, to
which is added fat in still smaller quantities; but that the fatty
element increases more and more as the process of disintegra-
tion goes on, separating, of course, from the earthy elements,
which also increase as the transformation progresses. Of the
34 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
earthy constituents, it is proved that the salts found are com-
posed chiefly of the insoluble phosphate and carbonate of
lime, mixed with a small proportion of the soluble salts of
soda. The difference, then, between tubercle and other albu-
minous compounds is very slight, so far as science is j^et able
to detect. Structurally and chemically, tubercle must be re-
garded as a product resulting from the working of vital pro-
cesses upon a plane where there is a constant tendency to fatty
and mineral transformations of albuminous matter.
It will be remembered that the phosphates and carbonates
of lime and soda, are remedies which have thus far gained
the highest reputation in the treatment of pulmonary tubercu-
losis with the dominant school, and that these have been sup-
plemented with cod-liver oil. Dr. Samuel Swan formulates a
principle asserting that the potentized preparations of an agent
are able to arrest the degradation or transformation of the same
matter moving upon a lower plane. What remedies have done
thus far in the treatment of consumption, has been largely with
matter which is found in tubercle when undergoing transform-
ation. Shall we gain anything by the use of highly potentized
matter of the same sort, is the question? Another question,
arises with us, based upon clinical experience. Sulphur in
the higher potencies has proved more satisfactory in its results
with some than any other agent; that is, it has served in the
largest number of cases. Has such service been done on an
eliminating basis? Sulphur is known to be the most univer-
sally eliminating agent of the materia medica. The facts may
be tentative to some generalization of very great importance ;
and yet, we do not expect to be able to do away with the most
thorough individualizing of our cases, and the close work of
differentiation as relates to remedies, if we are to succeeed in
To what extent this knowledge will be made scientific data,
to help in the solution of proper therapeutical measures to ar-
rest the mortality of this terrible disease, remains to be seen.
That the salts, which constitute a part of the tuberculous
matter, and which increase relatively in the transformation
going forward where soft tubercle is changed to hard or crea-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 35
taceous tubercle, should be the agents used most successfully
in the cure of the tubercular destruction, is a fact of much
significance. Does it assist in converting the soft tubercle
into the creataceous, might be asked? that would tend to ame-
lioration certainly. Do these agents give to nutrition correlat-
ing energy toward higher transformation? With these facts
before us, we can hardly say they are of no value. It is not
as clear that we know how to apply these agents to the best
purpose. Query: Is it not just possible that it is only some of
the liberated molecules even, in the more crude preparations,
which are freed from the cohesive force of crystallization, and
acting as a nascent force, which is the true causative element
of arrest in degradation ? Most transformations work in the
molecules ; perhaps all. Physical science asserts that the cor-
relating energy is exerted in the nascent state, while molecules
are passing from one plane to another. Is there not then a
scientific reason for using attenuations carried to the separa-
tion of the individual molecules; thereby bringing the mole-
cules into a condition to enter into new transformation? and
in passing into such a change, no doubt these molecules or
atoms would carry other atoms with them in a sort of catalytic
action or distribution of correlating force. The attenuations
are eminently worthy of trial.
Chemistry, it is presumed, has not yet made the ultimate
analysis of tubercle. Sulphur, and other minerals, no doubt,
will be found on a more complete analysis. Indeed it is pre-
sumable, that Sulphur is present in all albuminous products;
in the muscles, where fibrin is most abundant, it certainly
exists. It is one of the constituents of albumen. Exactly what
part it plays in the organic economies I am not able to say.
We shall have occasion to report some clinical experiences
with this agent in phthisis pulmonalis further along. Patho-
logists have classified tubercle: First, into miliary, where the
tubercle is of the size of a millet-seed, and is scattered exten-
sively through the tissue which is its seat; second, into infil-
trated, where the tubercular deposit occurs in diffuse masses,
such masses involving often the chief part of an organ or mem-
brane; third, into nodular or encysted, where the tubercle is
36 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
found in isolated, rounded bodies, from the size of a pea to a
hazel nut; and, lastly, they make the variety called the creta-
ceous or calcareous tubercle, which is the result of an absorp-
tion of animal matters from the primary exudation.
These divisions are more or less arbitrary, of course, and
not infrequently several of the varieties are found in a single
autopsy. Probably tubercular matter is essentially alike, the
difference in appearance being accidental ; for miliary tubercle
commonly is soft and can be crushed beneath the fingers, and
is of yellow color; as is the caseous; more rarely it is found as
a minute granule, and is semi-transparent or grayish, and hard
to the touch. Possibly, it may now have undergone the calca-
reous transformation retaining its millet-seed form. The miliary
tubercle, however, varies from what is called caseous exuda-
tion by being sprinkled throughout the lung, while the case-
ous exudation is usually confined to the apices. And yet, many
assert that miliary tubercle is very commonly associated with
the caseous exudation, the school of Bennett affirming, and the
school of Virchow denying, as a rule. But this is agreed, that
the diffuse tubercle is miliary. Then, again, it is affirmed that
infiltrated tubercle is often but an agglomeration of miliary
tubercle. Miliary and infiltrated tubercle are certainly found
in all shades of consistency, from the soft and diffluent to the
calcareous. It looks very much as if all forms of tubercle run
into one another. The soft certainly runs into the hard, and
all varieties we have named are found in the same lung. The
caseous and miliary exudations follow the same order in trans-
formation. In both varieties the miliary tubercle and the
cheesy exudation will be recent deposit, while the encysted
and cretaceous will be old deposit.
APPEARANCE OF THE LUNGS AS THE TUBERCU-
LAR DISINTEGRATION GOES ON.
The softening of tubercle commences at the center of the
tubercle-corpuscles, which become turbid, yellowish, cheesy or
opaque, and finally soften down into a purulent matter.
A group of tubercles soften and break down in many places,
corresponding to the number of corpuscles of which the group
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 61
is composed. As some groups will be more advanced in the
softening process, we shall find small primitive ulcers of a
tubercular character, and these may soon open into one another,
forming a common cavity as the intervening mass melts down
in the softening process. It is important to the management
of phthisis to understand how these tubercular ulcers enlarge
and continue their ravages in the lungs. Whenever the soften-
ing process has advanced to the breaking down stage, the sur-
rounding tissue takes on that degree of irritation or inflam-
mation which results in the sowing of a new crop of tubercles,
abundant or less abundant, according to the intensity of the
constitutional disease or dyscrasia.
These again break away and carry down the structures in
which they are deposited with a rapidity corresponding to the
intensity of the constitutional affection ; and so the destruction
goes on. If this process is so rapid as to exhaust the reactive
powers of the constitution quickly, the ulcer will be found to
have extended itself unequally in various directions, forming
an irregular and apparently lacerated cavity with its walls
loaded with softened tubercles. The internal surface of this
cavity will present a gnawed appearance, without exhibiting
evidences of a lining membrane as in the more chronic pro-
cess of disintegration.
On the other hand the walls will be loaded with pus globules
and the thin border of parenchymatous structure will be of a
dirty brownish discoloration and present a condition known
as canification. More often softening proceeds from several
points simultaneously, two or more cavities forming in near
proximity, which sooner or later open into each other; we even
find a number of cavities frequently communicating with each
other by sinuses or fistulous passages running in direct, or per-
haps tortuous courses, making the invaded lung look as if
scooped out into a multi-sacular cavern.
Bridges of parenchymatous structure will traverse these ab-
scesses in various directions, and shreds of tissue will be seen
hanging into the cavity. As the apices of the lungs are the
seat of most extensive tubercular deposit, here we shall find
the largest cavities as a rule. It is of interest to note how the
38 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
bronchi and blood-vessels are affected by this destructive pro-
cess as well as the pleura.
In cutting into a cavity and dissecting out the bronchial
tubes we shall find that the smaller or capillary bronchi have
undergone the same degeneration as the parenchymatous por-
tions of the lung, that their walls are filled with tubercles, and
also that the mucous membrane is implicated. Reaching the
larger tubes by extension of the lesion, they are perforated
and communication is established with the abscess or cavity.
Sometimes several bronchi are found opening into a cavity of
large size. The blood-vessels, which usually run in an oppo-
site direction, are obliterated as a rule, and are seen travers-
ing the walls of the cavity as ligamentous stripes. The arteries
are of such tissue formation that they more often withstand
ulceration, after the surrounding tissue has broken down. Still
it does happen much too frequently that the arterial walls are
thinned, and losing support, they give way, and dangerous
More commonly a slower process of disintegration is set up,
and the inflammatory action, which begins in the parenchyma
adjacent to the softening tubercle, and perhaps in lately formed
tubercle, throws out an albuminous grayish-white and viscid
This is regarded by eminent observers to be a curative pro-
cess on the part of nature, as it tends to close up the air-cells
and produce atrophy by compression. While this process is
going on, the walls of the cavity grow more even and regular,
and often become covered with a thin, grayish lining mem-
Laennic regarded this exudation similar to that thrown out
by cut surfaces or ulcerated surfaces in the healing process.
The parenchyma forming the walls of cavities also become
atrophied by the continuance of this process, all of which
tends to curative action and limitation of the ravages of a
Natuie's effort here is too often unavailing, it is true, but it
remains to be seen to what extent we can aid this effort of
limitation and arrest of degradation of tissue. The pleura is
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 39
often involved by abscesses reaching to the outer walls. Some-
times this is from softening of tubercles sown in deep-seated
structure and gradually working itself outward; but more of-
ten from softening of tubercles sown in the neighborhood of
When the abscess extends sufficiently to come in contact
with the pleura, we are apt to have that soften also and be-
come lacerated. Through this lesion escapes purulent matter
and air, giving us a severe pleuris}^ and pneumothorax, which
usually terminates in speedy death. Fortunately, more fre-
quently, the pleura has taken on such a degree of inflamma-
tion in consequence of adjacent morbic action, that we have
sufficiently firm adhesions to secure resistance to the disinte-
grating process at this point; the callous, cellulo- fibrous or fib-
ro-cartilaginous pseudo-membranes which are the product of
this inflammation, being the barriers of resistance.
These callous walls, however, do not always resist the de-
structive process. These adhesions, as we would suppose, are
more often in the region of the apices where tubercle is most
abundantly, as well as most frequently found.
When we have interstitial tubercular deposit, conjoined
with tubercular infiltration, we have rapid breaking down of
structure, causing what is popularly known as "galloping
In this variety we are more apt to have the pleura involved,
both, because of the rapidity of action, and because infiltrated
tubercle occurs for the most part in the apices, and is more
superficially seated. The appearance of the lung in addition
to what has been said, cannot be better described than by quot-
ing from "Pathological Anatomy," Part, I, by Rokitanski,
pages 138, 139 and 140:
" In the upper third of the superior lobes we generally find
a large cavern, surrounded inferiorly by several of a smaller
size, some of which communicate with the former; between
these we find yellow tubercles which are on the point of soft-
ening; a little lower down, gray tubercles, just becoming
opaque and discolored; in the lower portions of the upper,
and in the inferior lobes, a proportionately far smaller number
of gray, crude tubercular granulations."
40 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
The pulmonary parenchyma between the tubercles is found
in various conditions, according to the stage of the consump-
It is found normal, but more generally in a state of slight vi-
carious emphysema of its superficial parts, with hyperemia and
oedema of its deeper seated parts. But it is more important to
notice the atrophy of the parenchyma, induced in part by the
interstitial inflammation, partly by the obliteration of the
bronchi and air-cells, from the pressure exerted upon them by
the agglomerated tubercles, and in part by the obstruction of
the bronchi by the blenorrhoic mucous secretion. On the
other hand, croupous pneumonia may have attacked the
greater part of the parenchyma which is free from tubercles;
it appears partly as brownish-red hepatization, partly as gray-
ish-red, which are quickly converted into yellow tubercular
infiltration, and break down into abscesses in various places.
At other times, the pneumonia is followed by an exudation of
the gelatino-glutinous product already described. In the best
marked cases of this kind, the lungs are very voluminous,
and are coated with a grayish-yellow, generally thin, pleuritic
exudation, through which and the pulmonary pleura, we can
see superficial tubercular infiltrations, surrounded by emphy-
In the larynx we find tuberculous ulcers in various num-
bers and of different sizes; also aphthous erosions upon the
.tracheal, and at times upon the pharyngeal mucous membrane.
The mucous membrane of the bronchi which go to the ab-
scesses is in a state of infiltration to some distance, and the
tubes are filled with tuberculous matter; besides this, they are
always in a state of catarrh, with reddening and softening of
their mucous membrane, which secretes a muco-purulent mat-
ter, forming by far the greater proportion of the sputa which
are expectorated in the course of consumption. The bronchial
glands are enlarged and tuberculous in various degrees.
Externally upon the lungs we find pleurisies of various ex-
tents, and, with the most different exudations, their organiza-
tions and consequences. They occasion, at times, those very
acute pains in the chest, which so frequently annoy phthisical
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 41
patients. Except when they arise from superficial pneumonia,
they are generally developed during the softening down of
tubercles and the formation of the abscesses, and are compli-
cated with inflammatory reaction in the adjacent interstitial
cellular tissue. Among these the pleurisies around the apices
of the lungs and the body of the upper lobes are remarkable
for the constancy of their occurrence ; they correspond to the
favorite seat of tubercles, and deposit an exudation, which
either becomes organized into fibro-cellular bands, or into
thick, compact, fibrous swathes, which cover the upper lobes
from their apices downwards in the form of a cap; they are
thickest superiorly and gradually grow thinner from thence
downward; they bring about an intimate adhesion of the
lungs to the costal walls, and thus afford an effectual protec-
tion against perforation of the pleura by large abscesses."
Accurate diagnosis is important to the success of treatment
in our cases of phthisis, as well as in other grave lesions of the
body; diagnosis in advance of tubercular exudation if possi-
ble, but at the inception of exudation, at all events.
In acute miliary tuberculosis there may be much difficulty
in applying percussion to advantage, as the resonance is not so
much diminished as to be easily detected, condensation not
being sufficiently pronounced. The respirations, however, are
likely to be increased, the dyspnoea more marked, and the
more on going up-stairs and from rapid walking. Then again
we may look for the prolonged expiration which occurs from
pulmonary obstruction. Guttman says: "The thoracic reson-
ance may be perfectly normal during the first stages of phthi-
sis," and that it suffers but slight modification when patches
of healthy lung tissues are still found between the condensed
portions. This is good authority, yet we do not believe tuber-
cular deposit can go on to any considerable extent without
42 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
diminishing the resonant capacity of the lungs. In addition
to obtaining the facts upon points already named, we may use
the spirometer and thus determine the vital capacity; if there
should be found a loss of forty cubic inches in lung capacity,
it would denote condensation of a cubic inch of the lungs and
suggest tubercle. Dr. Radclyffe Hall, of London, says: "To
know how much air a man does habitually consume is second
in importance to no other fact in determining his condition.
It is a symptom to be noticed and measured in every case of
disease, most especially diseases of the lungs; the great and
most satisfactory deduction being, that if on a proper examina-
tion, the lungs of any given person are working freely and
fully, one thing is demonstrably true, he or she certainly has
nothing like consumption. On the other hand, just in propor-
tion as a person is habitually breathing less air than he ought,
in such proportion is he falling fast and surely into a fatal
disease." This tendency to consumption can usually be dis-
covered years in advance of actual occurrence of the disease.
In the early stages of consumption the spirometer is of much
more value, it seems to me, than auscultation or percussion.
Jerking Respirations. — The jerking respiration is another
symptom of condensation. This term is used to describe a
vesicular inspiration, which divides into two or more parts;'
should the air-cells in the apices, for instance, become partially
blocked by infiltration of a caseous degeneration, and the bron-
chii at the same time be reduced in size by tumefaction of the
mucous membrane, the lung tissue would be less accessible to
air, and the air would reach the cells later than the freely
permeable lung would expand, — this gives a jerking or inter-
rupted way of breathing. More often, perhaps, it may point
to incipient catarrh of the apices, but this is a precursor of
cheesy condensation. Says Guttman : " Experience shows that
catarrh of the apices is seldom primary but usually secondary,
indicating the beginning of caseous condensation in these
The Rough Murmur. — The harsh or rough vesicular mur-
mur, if heard in one or both apices and remaining perma-
nently, furnishes good grounds for suspicion of a phthisical
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 46
Prolonged Expiration. — Prolonged expiration, as we have
said, is one of the earliest signs of the commencement of tuber-
cular deposit or cheesy degeneration. It is often attended with
rales, either dry or moist, which point to the same inference ;
it always points at least to a hindrance to the free escape of
the air. A point to be made is that in cheesy condensation
the murmur is more localized than if caused by other obstruc-
tions than tubercle.
Force in Expiration. — In the healthy person the force of
expiration exceeds that of inspiration; upon this fact diseases
of the lungs have been divided into two pneumatrometric
types. When the positive expiratory pressure becomes less
than the negative inspiratory force, we may be sure of diminu-
tion of elasticity in the lung-tissue, as in bronchitis, nervous asth-
ma and pulmonary emphysema. When the inspiratory power
is lessened, it is clear that there is a resistance to expansion of
the lung-tissue, and this may come of stenosis of the trachea and
larynx ; from pneumonia, pleurisy and tubercle. In tubercle
the inspiratory power is lessened when the disease is of very
slight extent. In diagnosis we will easily be able to say
whether this diminution of inspiratory power comes of stenosis
of the larynx, from pleurisy, and very likely if of pneumonia,
especially if we take the entire history of the case into account.
Diminished force in inspiration then becomes a valuable
symptom in the diagnosis of tuberculosis of the lungs, espe-
cially in the early stage. A careful examination covering
these points will very definitely enable one to decide whether
they have an incipient phthisis in progress of development,
certainly if family and private history and temperament be
carefully studied. This early period of the disease is most im-
portant to be made out, as at this stage a large per cent, of
phthisical cases are curable, while if left to the course of nature,
at no very remote period, a large majority of the cases are not
found amenable to remedies. The latter stages of the disease,
of course, are more easily determined by physical diagnosis,
and this should be carefully applied.
Configuration. — Abnormal changes in the thoracic walls
are important to note in all examinations for thoracic diseases.
44 PHTHISIS PULMONALIS : TUBEKCULAB, PHTHISIS.
A typical chest is noted for the symmetry of the two sides ver-
tically and in each circle from the sternum to the spine. The
supra and infra-clavicular spaces should round up nearly level
with the clavicles, with a gradual swell of the chest to the nipples
and then a gradual return curve, leaving the walls most promi-
nent at the fifth rib; the vertebral column and sternum should
be vertical or nearly so, and the scapula placed so as to keep
the generally swelling curves complete, w T ith a symmetrical
depression in the line of the vertebral column, from which the
spinous processes stand prominent. From a typical chest dif-
ferent deviations can be studied; there are a few deviations
which are physiological and of no importance as bearing upon
a morbid condition of the lungs — undue prominence of the
clavicles in the line of the costo-sternal articulations, and pos-
sibly of the sternum itself, belong to this class. Depressions
may also exist and more often in the sternum than elsewhere,
especially the inferior portion, and is often the result of the
last of the shoemaker.
Changes which indicate pathological conditions are what
we wish to study ; of these, expansion and contraction are most
important to note. Expansion may be upon one side or upon
both sides; this may be brought about by hepatization of the
lung, if complete, but more often it comes of morbid growths,
or the presence of air, serum, or purulent matters within the
pleural sac. Pleuritic effusions not unfrequently occupy so
large a space in the thoracic cavity as to cause very consider-
able enlargement. The first indication of enlargement in
these cases is that of flattening of the intercostal spaces, as the
muscles become inactive from the limited range of movement
of the lung. Both the vertical and transverse diameters are
increased when large accumulations have taken place ; if the
morbid product be a fluid, it will occupy the lower portion of
the thoracic spaces, and change as the patient changes position
from the sitting to the recumbent posture, or from side to
side; this makes pleuritic infiltrations easy to determine;
morbid growths or misplaced viscera have no such mobility.
Pneumothorax, or air in the pleural sac, presents the same
external conformation of the chest as does pleuritic effusion,
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 45
but it is usually more sudden, often coming from a fractured
rib, a stab, or a gunshot wound, more rarely from the rupture
of some pulmonary cavity, which communicates with one of
the larger bronchi. Then the resonance of air upon percus-
sion is quite unlike the dulness of serum, nor does air gravi-
tate as does water. Bulging of the lower portions of the thorax
when upon the right side, if not of pleuritic effusions, is usu-
ally from morbid enlargements of the liver, such as hydatids,
and when upon the left side more commonly from enlarge-
ment of the spleen.
In pneumonia we have usually an acute attack with highly
inflammatory symptoms; we also have as a rule the lower
lobes of the lungs as the seat of the attack, especially does this
hold good of the right lung; yet we may have the upper lobe
or the middle lobe, or even both lower lobes as the seat of
attack. When the entire lower lobe is affected we have reso-
nance diminished as high as to the middle of the scapula
posteriorly; if the middle lobe be the seat of attack dulness is
most clearly detected between the fourth and fifth ribs. In
pneumonia of the apices the dulness extends down to the
fourth or fifth rib ; if the whole lobe is hepatized we are able
to trace externally the outlines, as* the lobe so consolidated
increases considerably in bulk, and the region occupied be-
comes expanded. There may be isolated patches with pneu-
monic infiltration, and the percussion note not be altered, so
resonant is all the surrounding tissue. Pneumonia in the
middle of the lung presents similar difficulties in the way of
Hepatization presents us a condition of complete consolida-
tion and a corresponding dulness ; other varieties of pulmo-
nary condensation will have a measure of dulness modified
by locality and density of the lung. Cheesy exudation and
chronic insterstitial pneumonia, involving usually the apices
of the lungs and known often by the collective, term phthisis,
give us the most marked examples of condensation outside of
hepatization of the lungs. In the disease known as cheesy
pneumonia in Germany but as caseous exudation in England
and America, condensation of the lung may occur in both
46 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
upper lobes, but seldom at the same time with equal severity.
If the attack is uni-lateral it is usually upon the right side.
Dulness in such attacks is most marked in the supra-clavicular
regions and on the clavicles themselves. Possibly the dulness
is most marked in the supra-spinous regions fixing the exu-
dation in the posterior apices. If the condensation extends
downward the dulness extends with it, and this is frequently
the case too as low as the fourth rib. Exceptionally the per-
cussion sound may be tympanitic in the supra and infra-
clavicular space in a case of caseous infiltration, but the so and
will always be muffled and tone does not change when the
mouth is open.
Depressions upon the Surface. — A group of pathological
symptoms more definitely related to our subject, is where we
have circumscribed depressions of the surface; they follow
shrinking of the lung from any cause which may occasion a
collaj)se, but by far the most common cause is caseous conden-
sation of the lungs. The reason of the depression is clear, for
when the lung fails to occupy as much space by reason of con-
densation, the walls become depressed from the force of atmos-
pheric pressure acting upon the outer walls. The upper an-
terior portions of the chest in the supra and infra-clavicular
regions, are the points where such depressions are most fre-
quently found. There is likely to be little depression on the
lower posterior portion of the chest, even if the lung tissue
has shrunken away, because of the large and powerful dorsal
muscles. Tubercle is not nearly as frequently found in the
lower lobes of the lungs, however, and depressions here are
more likely to be from other causes. In chronic interstitial
pneumonia the pulmonary contraction is often very marked,
especially if the subject be a child. There is a kind of chest
malformation which depends upon structural development,
and has its origin, no doubt, in faults of nutrition, as has
rachitis and kindred affections.
It will be recognized as the consumptive chest, long, thin
and narrow, with wing-like projection of the shoulder-blades,
the scapular end of the clavicles prominent; associated with
this chest we have the elongated neck, long extremities, deli-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 47
cate skin and possibly distorted joints of the fingers. A con-
formation favoring condensation because of the cramped spaces
which prevent the free action of the lungs. Presumably the
low grade of vitality which such a condition indicates is the
first and the greater cause after all.
Thoracic Measurements. — It is quite well to take the
measurements of the chest when estimating the condition of
soundness or unsoundness, and yet to a practiced eye very
slight variations in the form and capacity of the chest will be
pretty accurately judged of, simply by inspection, some varia-
tions are even better detected by the eye. The tape and calli-
pers have commonly been resorted to for obtaining thoracic
mensuration. It should be remembered that the right lung is
usually the larger. The circumference taken at the point of
the nipple and lower angles of the scapula, when the arms are
raised and extended, is a fraction less than 32.3 inches in the
average man at the end of an ordinary expiration, and not far
from 34 inches after a deep inspiration. In old age it dimin-
ishes somewhat. The measurement at the ensiform cartilage
also shows that the lower respiration increases while the up-
per diminishes as age advances. The above are Trolich's num-
bers. The diameter of the chest taken from the clavicle to the
base of the chest is called the long diameter ; diameters taken
from any point on the sides to a corresponding point upon the
other side, and from a point anteriorly to a corresponding point
posteriorly, are called respectively transverse diameters and
antero-posterior or sterno-vertebral diameters. The long di-
ameter is very variable. The sterno-vertebral varies from a
little less than 6.3 inches superiorly to 7.5, or nearly, inferiorly.
The transverse diameters run from 9.8 to 10.2, and a little more.
Women give smaller diameters as their type of organic life is
Respiratory Movements. — The lung movement corre-
sponds to the movements of the thoracic walls ; such move-
ment takes place in two directions, from above downward and
from behind forward, the apex being the fixed point of the
first, and the latter having a fixed point at the posterior cen-
ter of the lung probably. Any considerable inequality of
48 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
movement is easily detected by the eye and points to some
obstruction in the lung tissue. Such differences are more
easily detected with the person standing in profile; the move-
ments of the shoulder-blades also are quite diagnostic ; should
the obstruction be situated in the upper lobe of one or both
lungs, the more common point of tubercular deposit, the lim-
itation of the chest movements is seen to be in the upper
thoracic region ; if only one side is affected, on the affected
side of course; if both lungs, the embarrassment extends
across over both sides; but in this event it would be more
difficult to judge of it because of having no sound lung by
which to compare the movements. Again in cases where we
have extensive softening of tubercle giving a large cavity, it
has been noticed that at the time of inspiration there is marked
depression in the walls at that place and at the time of expira-
tion there is seen a bulging prominence. This is accounted
for on the theory that the lung being condensed by tubercle it
is inexpansible and does not follow the chest walls when raised
by inspiration. We have also depressions from vesicular em-
physema and croupal strictures, but these are more often seen
at the supra- clavicular regions above the sternal notch or in
the lower lateral intercostal spaces in the region of the epigas-
trium. A very low respiration again is often diagnostic of tu-
bercle. When an impediment to the passage of air into the
upper portion of the lobes of the lungs exists, the lower lobes
act more vigorously, the diaphragm contracts more powerfully,
and the chest inferiorly swells and broadens in an exaggerated
manner. Carefully studied these various peculiarities help make
out a correct diagnosis. When studying the respiratory move-
ments we should remember that in women the thoracic move-
ments tend to decrease from above downwards, and also that
in young persons the upper portion frequently moves more
than the lower portion, a condition reversed in old age.
Frequency of Respiration. — From sixteen to twenty respi-
rations may be set down as about the average number per
minute in the healthy adult male, rather less than more; some
allow one respiration to four pulse beats — in sleep this is per-
haps very nearly correct. Many causes operate to increase the
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 49
frequency of respiration; among the more marked we may-
mention impoverishment of the blood, and diseases of the heart,
which prevent a proper return of the blood, stenosis from
croupal exudations, pleuritic pains which limit expansion of
the lungs, and obstruction from pneumonic and tubercular
infiltrations. The value of this frequency of respiration is of
most importance in judging of the extent of the infiltration.
Shortness of breath should be looked upon with suspicion
when not adequately accounted for from other causes. It is
not always increased, however, even when considerable pro-
gress in a tubercular disease has been made. The volume of
blood is known to determine largely the character of respiration.
When by the progress of a chronic disease, like tubercle, the
system has become impoverished of blood, the lungs, even
though greatly crippled, will be able to perform a necessary
function, to so small a volume of blood, and hence little acceler-
ation of breathing will be present.
The practice of percussing the thoracic walls in the study of
tubercular affections of the lungs has become a part of every
thorough examination, and its importance is not likely to be
overestimated. Two methods are used, the mediate and im-
mediate ; the immediate, which was the method of Auenbrug-
ger, is performed by striking the walls with the finger-tips
directly ; the mediate is where some substance intervenes and
is struck upon; this may be the finger or a pleximeter, and
we may strike the pleximeter with the finger or a hammer.
The important fact is to familiarize the ear to the normal
sounds of the chest and to learn to detect any variation, espe-
cially dulness, if we are looking for tubercular exudation. We
prefer the index or second finger of the left hand, firmly ap-
plied to the walls, to any other media ; this can be better fitted
to the uneven surfaces than the pleximeter, and the blow is
50 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
given with the middle finger of the right hand to bring out
the chest sounds. Certainly if we wish to define sharply the
bounds of sound and unsound structure, this is the most feasi-
ble way. Others prefer the glass or ivory pleximeter and
strike with the finger or hammer, as they may choose. Flint
has invented a good percussor and pleximeter, and Winterich
has also invented an admirable percussion hammer which is
manufactured by Tiemann. Those who are curious in these
matters will consult some handbook on physical diagnosis.
By any of these methods a nearly absolutely accurate result
may be obtained, provided the physician has attained to skill
in the performance of his work, if we except those cases here-
tofore discussed. It may be said of a skilful digital manipu-
lator that he will use the hammer almost equally as well,
while one who learns by the hammer does not prove to have
gained much in the way of qualification for a good digital ex-
aminer. A very important point is that one possess a very
sensitive ear, and this needs to be well trained to the different
vibrations in sound; quality of sound and volume of sound
are to be very carefully studied. The stroke is also of im-
portance ; if there be overlying tissue of considerable thickness,
as in the mammary and supra-scapular regions, and some
places covered with the larger muscles, it will require a stroke
carrying much more force, in order to bring out from the
parenchymatous structure the representative sounds, than on
places covered with but little material to embarrass sound.
Again, we may want to bring out sounds from structure con-
taining air underlying other internal organs, especially would
this require a forcible impulse upon the walls, contrariwise, it
will be necessary to give a gentle blow where the walls are
thin and the structure being explored is superficial. In fol-
lowing down also upon the border of the liver, a gentle stroke
gives the boundary between lung-tissue and hepatic tissue
much better than the forcible impulse.
The principal factor in the production of thoracic sounds,
is the vibration of air contained in the pulmonary air-cells;
to this is added the vibration of the chest-walls and the ten-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 51
sion of the parenchyma of the lungs; this is proven from the
fact that as the air vesicles become occluded, dulness of sound
increases as in tubercular infiltration and hepatization. But
a lung out of the thoracic cavity is not as resonant as one
in, so we must conclude that something of resonance is ob-
tained from the walls; and then, pathological changes modi-
fying tension, modify resonance also. In relation to the
quality of sound perhaps the terms clear and dull, or resonant,
and dull, may convey what is meant as well as any, although
attempts have been made to amplify and improve our nomen-
clature — muffled or obscured may be added if we wish for
nicer distinctions. When we have less than normal resonance
in a percussion sound, we may expect one of two conditions,
either that the air vesicles are obliterated by plastic exudation,
or that they are closed from pressure such as would follow
from the presence of fluids in the pleural sacs or tumors within
the thoracic spaces. Of dulness due to infiltration we need to
study carefully that of hepatization from caseous degeneration
and other forms of tubercle, also that of emphysema and the
products of pleurisy. In the first stage of pneumonia, even
though the capillaries become strangulated and over-distended
with blood, the thoracic resonance is normal ; it is only at the
end of the second stage when the alveoli are filled with plastic
exudation that the intensity of sound diminishes. If the infil-
tration goes on instead of being absorbed, and remains a per-
manent impediment in the form of chronic induration, we
have what is known as a hepatized lung with the dull liver
sound. In a case of hepatization you will not only have dul-
ness, but bronchial respiration much more marked than in
other forms of condensation. The character of the acute attack,
the rust-colored sputa if we have it, will help to distinguish a
pneumonic hepatization from tubercular condensation. In
diagnosticating as to whether dulness in the lower lobe comes
of hepatization or vesicular emphysema, it is important to
define accurately the boundaries of the border of the right
lung ; for if it does not go beyond the normal limits it may be
safely concluded that we have no emphysema. Dulness from
effusions are distinguished from both tubercle and hepatization
by their mobility, thus shifting the place of dulness, espe-
52 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
cially the upper border. It is of importance when comparing
the probabilities of tubercular condensation as against hepati-
zation, to remember that the caseous exudation occurs far
more frequently in the apices of the lungs than elsewhere,
while pneumonia attacks the lower lobes, especially upon the
right side. It is not common to have both apices attacked at
the same time, though possibly they may be ; but it is very
common for the disease to propagate from one apex to the
other in tubercle. Dulness produced from caseous exudation
into the apices, is usually most marked from percussing the
clavicles and the infra-clavicular spaces. The tone in the
supra-spinous regions also becomes dull if the whole of the
apex is involved, whether the condensation be more anteriorly
or posteriorly may be judged of by increase of dulness where
the condensation is most marked. Infra-clavicular dulness
follows with the progress of condensation downward in the
superior lobe which may extend as far as the fourth rib. We
have occasionally found the lower portion of the upper lobe
infiltrated, while the apices appeared to be comparatively free;
especially have we met this after imperfectly cured pneumonic
Hemorrhagic infarctions caused by mitral. lesions are some-
times met with, but they occur in the middle and lower lobes
of the right lung usually, and the valvular sounds and history
of case will clear up all doubts in such cases. Tumors in the
mediastinum sometimes are met with, but they are not likely
to be mistaken for tubercular condensation.
Degrees of Resonance. — Degrees of resonance and dull-
ness are much more readily made out in all places where
sound can be properly eliminated, from the gentle tap than
the more energetic blow. Of course in children there is less
need of a strong blow, and if given, might possibly deceive
from the fact that the impulse would be likely to call out reson-
ant sounds from the abdomen ; over tubercular places where
softening has begun, and over cavities, gentleness in our ex-
plorations is necessary if we would avoid pain, and possibly
hemorrhage in consequence of violent coughing which we
may provoke. In percussing the back the patient should be
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 53
required to fold his arms in front so as to give all possible
space between the two scapulas, also in percussing over the
region of the supra-clavicular fossae, the patient should look
directly forwards and keep the head erect, so as to avoid ten-
sion of the muscles spreading over this space, which would
obstruct sound. Percussion should be carried on symmetrically,
comparing one side with the other, as any difference in sound
is best detected by this method, and work from above down-
wards; on the right side this may be carried to the edge of the
lung, on the left side the heart will be. encountered at the
fourth rib. Lateral examinations can be instituted and com-
parisons made till the fourth rib is reached, when the space
occupied by the heart will have to be deducted. Similar ten-
sion of muscles upon the two sides should be maintained, if
we are to make accurate and nice comparative distinctions.
The details well carried out often makes the difference between
accuracy in diagnosis, and an examination of no practical
CHARACTER OF TONES.
Different tones following the percussion blow have been
classed as tympanitic percussion sounds, tracheal resonance,
amphoric resonance and the cracked-pot sounds. These have
some significance in following out a tubercular condensation
as it. goes through different periods of transformation.
Tympanitic Sounds. — Any condition which favors retrac-
tion of the lung tissue may give rise to a tympanitic percussion
sound. Pleurisy, pneumonia, oedema and caseous condensation
may all produce retraction ; but it is in the apices chiefly that
this will be observed, and will be heard in the supra and
infra-clavicular spaces. The sound will be somewhat muffled,
and the pitch will not change on opening or shutting the
mouth, a point which will distinguish condensation from a
cavity here. It is owing to the tissue not being completely
infiltrated, some of the alveoli yet filling with air, while at the
same time the lung tissue is relaxed. The tracheal resonance
is found almost exclusively upon the left side, and is probably
due to the greater length of the chief bronchus on that side;
54 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
it more often is the result of pneumonic infiltration filling
completely the upper left lobe than anything else. The tone
is louder on opening the mouth, and deeper on closing it.
The Cracked-pot Sound. — The cracked-pot sound occurs
when cavities exist in moderate size ; in thoracic fistula which
may follow the use of the trochar; in pneumothorax from gun-
shot wounds or stabbing, possibly in pleurisy and in pneumo-
nia. There will be this difference if it come of either of these
last conditions: the cracked-pot sound will not be augmented
by opening the mouth, while in the other cases it will be very
considerably increased. By far the most common cause of its
production is vomicae in the upper lobes, and if a patient is
known to be tuberculous, it may be considered diagnostic of a
Amphoric Resonance. — The amphoric resonance is heard
where large cavities exist, and where there is an accumula-
tion of air in the pleural sac. Apart from the percussion
stroke the sound depends for the most part upon . the size of
the cavity, if it be from tubercular disintegration. It is in-
creased somewhat by opening the mouth — the sound is almost
identical with that produced by striking on the side of an
empty cask or large india rubber ball.
As in percussion there are two methods of auscultation,
mediate and immediate; the immediate being that of apply-
ing the ear directly to the walls of the chest, and the mediate
where the stethoscope is employed. Applying the ear direct
has some advantages; the sounds are more distinct, while a
larger area can be examined at the same moment. It is neces-
sary sometimes to go through an examination rapidly, because
of the weakness of your patient : this method at such a time
has great advantage. It may be more difficult to adjust the
ear to such points as the supra-clavicular spaces, especially if
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 55
much emaciation exist ; again if there should be hair upon
the chest the friction occasioned by respiration might mislead,
but the application of a little water would obviate this friction
sound. If it were necessary to confine the exploration within
very narrow limits, the stethoscope would have great advan-
tages, so it is well to familiarize the ear to both methods.
Although very satisfactory examinations are made when the
chest remains covered with the chemise, the ear applied to
the walls of the chest direct gives the sounds more distinct,
and this adds to certainty; and very few after proper expla-
nation will object. A thin handkerchief will less obstruct the
murmurs than the chemise. As an early diagnosis of tuber-
cle in the lungs is of more practical importance than a later
one, and as such diagnosis is much more difficult to be made
in the inceptive stage of tuberculosis, a thorough and com-
plete examination is imperative. Education of the ear to
normal and abnormal sounds becomes necessary to a good
auscultator. If the stethoscope be used, care should be taken
not to press too hard on the thoracic wall, as this is painful
where there is emaciation. Sounds produced by both inspi-
ration and expiration are to be studied. These sounds have
been classified into : first, simple respiratory murmurs; second,
rales occurring during respiration and produced by the pres-
ence of fluid matter in the bronchi or parenchyma of the
lung; third, friction sounds coming from the rubbing of
roughened pleural surfaces upon each other; and fourthly,
sounds arising from the cough and voice. Skoda divides the
simple respiratory murmurs, both in the sound and diseased
lung, into three varieties: first, the vesicular respiratory mur-
mur; second, the bronchial respiratory murmur; and third,
the indeterminate respiratory murmur. The first is produced
at the instant at which the air passes into the alveoli; how
the murmur is produced is not well understood. Skoda and
Laennec thought it arose from the friction of air against the
cell walls while in a state of dilatation; Niemeyer and others,
say that it is caused by a temporary stenosis which takes
place in the minute bronchioles. Baas regards that all respi-
ratory murmurs are of tracheal origin, being modified by the
56 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
resonant spaces to which the air is conducted; in the bronchi
it is bronchial respiration; in the alveoli it is vesicular. The
vesicular murmur over the healthy lung is most intense where
the walls are the thinnest; hence it is louder anteriorly than
posteriorly; most intensified at the infra-clavicular spaces;
weakest at supra and infra-scapular regions. Wherever the
lung tissue becomes thin the murmur also weakens, as at the
apices and the inferior borders. The vesicular murmur is
audible only during inspiration; this murmur has been di-
vided into the rough murmur and the soft murmur ; the nor-
mal murmur is soft, but any impediment to ingress of air to
the alveoli gives a rough or harsh murmur. For instance, if
the walls become thickened by a catarrh, the hypertrophy
produces the harsh vesicular murmur; this rough murmur
may be circumscribed, or it may extend to the whole lung;
it is of diagnostic value to decide if the rough murmur be
strictly confined within narrow limits if we would determine
the nature and cause of our catarrh ; for if it be at the apices
it is suggestive of caseous exudation — a primary catarrh
rarely commences here; if of secondary origin, as has been re-
marked, there is probably tubercle in the apices. The harsh
sound, however, is heard over the whole lung in simple bron-
chial catarrh, as also in secondary bronchial inflammations
with complications. The circumscribed character is the im-
portant diagnostic point; this, taken together with associated
symptoms will determine the existence or non-existence of tu-
bercle. In children under twelve years of age we have the
harsh murmur as a normal sound, and it is called in this case
Jerking Inspiration. — Another variety of the" vesicular
murmur has obtained the name of jerking inspiration. This
will occur if the alveoli of the apices become obstructed with
caseous exudation, or even if the lung-tissue become infiltrated
from any cause — the more common cause, however, being
tubercle. The reason for the sound is that the finer bronchi
become narrowed, either by compression or thickening of the
walls of the bronchioles, or both. This condition does not
admit the air as readily into the air-cells, occasioning the lung
PHTHISIS PULMONALISI TUBERCULAR PHTHISIS. 57
to be later in expanding — a fact which gives the interrupted
inspiration. This will be likely to disappear after repeated
full inspirations or after an attack of coughing, for a time,
only to return, however, after a little. Possibly this character
of respiration may exist from other obstructive causes of a
temporary nature, when, of course, no serious import would
attach to it; but if it continue for any considerable time,
the fact is very significant as pointing to a serious invasion of
the apices. Conjoined with this peculiar murmur, we shall
also be likely to have prolonged expiration if tubercle exist in
the apices. Collapse of the lung from aqueous effusions, py-
emia or emphysema would abolish the vesicular murmur
entire; also in extensive hepatization it would no longer be
heard wherever such condensation existed. Occlusion of one
of the principal bronchi by a foreign body would also so
diminish the murmur as to well nigh make it imperceptible
to the ear.
The Expiratory Murmur. — This is a sound produced by
the egress of air through the bronchial passages ; it is a sort
of buzzing, not very well defined sound, much shorter than
the vesicular murmur and wholly dissimilar in character.
The abnormal expiratory murmur may be of two classes : the
prolonged and the harsh murmur, and more often both will
be found together. The prolonged expiration always indicates
obstruction to freedom in the escape of air ; it attends severe
bronchial catarrh, as such attacks thicken the mucus walls of
the bronchi; it is even more marked in cases of diffuse bron-
chial catarrh associated with emphysema. It is also found
connected with condensation of the lungs, but in this case
more localized. If limited, for instance, to one of the apices,
it is one of the earliest indications of caseous exudation. The
harsh expiratory murmur, also caused by obstruction, has
about the same significance.
Bronchial Respiratory Murmurs. — They occur in conden-
sation of the lung tissue and in pulmonary cavities. As pneu-
monic hepatization affords the highest degree of condensation,
so the bronchial sound is most sonorous in this variety of con-
densation. If the lower lobe be the seat of hepatization, this
58 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
bruit is likely to be heard from the base of the lung to the
middle of the scapula; should the pneumonia, however, be
circumscribed, as possibly it may be, the bronchial sound
might not exist at all, for there must be bronchi of sufficient
size included in the condensed portion to yield the bronchial
sound, or it will be absent. The sound also ceases upon the
clearing up of the hepatic infiltration. In cases of caseous
condensation and in chronic interstitial pneumonia associated
with dilatation of the bronchi, the bronchial respiration is
found, but never so intense as in pulmonary hepatization, both
for the reason that the dull spaces are more limited, and be-
cause there is likely to be more or less of the alveoli in the
immediate locality still admitting the air, which always dead-
ens the murmur. The bronchial sound will occur whenever
the lung is rendered void of air from any cause. Pleuritic
exudations, pneumothorax, hypertrophy of the heart, etc., all
yield the bronchial sound. Softening of tubercle and the
opening up of cavities in the lungs, however, is the more com-
com cause. The vomica? must be of some size, and if situated
superficially, this favors the production of a bronchial sound.
The size of the bronchi which opens into the cavity has much
to do with, the intensity of the sound ; it is also increased by
the energy of the respiration. It is not often, however, heard
in the smaller cavities, especially if they be removed from the
larger bronchial tubes. A modified bronchial murmur has
been introduced into handbooks of physical diagnosis from
Seitz. It occurs only at the time of inspiration; it is a very
harsh murmur, such as is heard in cases of stenosis of the
bronchi, or diffuse bronchial catarrh of long standing allied
The sound continues for about one-third of the length of
the inspiration, which is then followed by a metallic echo,
rales and other bronchial murmurs; it is always associated
with cavities, and for the most part is heard in the upper
Amphoric Respiratory Sound. — This again has the metal-
lic tone or echo; it owes its name to its resemblance to the
sound produced by blowing into a bottle, where the air passes
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 59
from, a narrow space into a large chamber. It may occur at
the time of inspiration alone, at the time of expiration alone,
or in both cases, but is generally loudest when it accompanies
expiration. The cavities must be large in order to obtain the
conditions necessary to its production. It occurs also in cases
of accumulation of air in the plural sac. As the majority of
pulmonary cavities are to be found in the upper lobes, of
course here is where we more frequently find the murmur ;
and as the walls are thinnest anteriorly, there the sound will
be heard most pronounced.
Indeterminate Respiratory Sounds. — Skoda in differentia-
ting between the vesicular and bronchial respiratory murmurs
found transition murmurs which could not properly be classed
as either bronchial or vesicular, which he named indetermin-
ate. It needs a trained ear to appreciate this kind of murmur.
One cause of the murmur seems to be a shallow inspiration ;
this sends the air with too little force into the air-cells to ob-
tain the vesicular murmur, especially where coverings of the
chest walls are thick as about the shoulders. A forcible res-
piration will usually bring out a clear vesicular murmur.
The causes are, first, insufficient expansion of the air-cells ;
second, obstruction of a large bronchus or of several smaller
bronchi where there is infiltrated lung tissue, and generally
with it there will be abundant secretion of mucus. This oc-
curs in cases of caseous exudation associated with a bronchial
catarrh. Indeterminate sounds in such cases often disappear
after coughing and clearing out the mucus obstruction. Lastly,
all pathological murmurs become indeterminate when marked
by loud rales.
In normal respiration we have no rales, but as soon as the
mucous membrane of the respiratory tract becomes uneven
by thickening or hyperplasia, and the mucus glands begin
to throw out mucus freely, we have accessory sounds added
to the normal murmur, and these have obtained the name
of rales. The manner in which these rales are produced is
very variable, depending upon the peculiar pathological con-
ditions present. They are produced in the alveoli, in the
60 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
larger and smaller bronchi, and in cavities of the lungs. For
the most, they are dependent upon the action of air entering
fluids and forming bubbles which break in the bronchi or
cavities with a crackling or explosive sound. Possibly in the
alveoli and minute bronchioles the rales may be produced by
air passing over the fluids at the time of contraction and ex-
pansion. Rales are divided into two varieties, the moist and
the dry; difference in the consistence of the secretions being
the cause of the different sounds; the moist being caused by
thin and wateiy secretions, and the dry by thick and more
tenacious secretions. The moist rales are quite like to the
breaking of soap bubbles in character of sound ; the finer rales
are more like the sounds produced by rubbing the hair be-
tween the fingers or the crepitating sound of salt when thrown
upon fire. The constituent character of the fluid producing
the rales is not usually easily made out from the rales. It
may be judged of when determined whether the rales come
from cavities or bronchial tubes, and the seat of the rales is
not usually difficult to be made out. Rales are audible in all
stages of respiration, rather more frequently perhaps in inspi-
ration. Very commonly the fluid in which the rales are pro-
duced is lodged in the bronchioles, and in such cases the rales
occur at the acme of inspiration and at commencement of
expiration. Should the secretion be so abundant as to be
found in the larger bronchi at the same time, the rales would
be almost continuous. We have rales in the respiratory pause,
and they indicate cavities in the lungs. Guttman says that he
has never heard them except in connection with large cavities.
Rales are scanty or abundant as the case may be; their num-
ber depends upon the amount of fluid in the alveoli, bronchi
and cavities, as well as the proximity of the lesion to the
thoracic walls. Persistent and abundant rales have been
spoken of as gurgling rales; such are found more commonly
in connection with cavities of considerable size secreting very
copiously; possibly they may be found in connection with
aggravated catarrhal attacks of the smaller bronchi.
Intensity of the Rales. — Intensity corresponds to the
energy of the respiratory act and the quantity of fluid present;
it is also increased by the extent of tissue involved, and if it
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 61
be near the walls it is the more readily communicated to the
ear. The larger bronchi always give a louder rale than the
smaller or the air-cells. If the rale come from the larger
bronchi, it is not necessary that there should be a great amount
of fluid to get a very decided rale, the surface being very con-
siderable here and superficial to the ear, while in the finer
bronchial tubes the rales, though numerous, are not easily de-
tected without the aid of mediate or immediate auscultation.
Though they should be very pronounced in cavities even, they
are not as distinct to the ear as the rales from the larger bronchi }
for the obvious reason that they are farther removed from the
ear, and come to the ear through walls which intercept the
sound. Then again if the stethoscope be used, the nearer the
cavity to the stethoscope the more intense the sound, and it is
to be remembered, that the louder rales will be carried farther
than the feebler rales. Galvagni claims that rales in the deeper
structures are heard most accurately from the mouth; others
think such a statement requires modification; certain it is that
rales in the apices are heard surprisingly loud if the stetho-
scope be placed near the mouth. Rales have again been divi-
ded into fine bubbling rales, coarse bubbling rales, and medi-
um-sized bubbling rales. The distinction is valuable perhaps
for determining the locality of the rale ; the fine usually will
be generated, as we should expect, in the bronchioles, and the
coarse in the larger bronchi and cavities. The fine uniform
bubbling rale is more often known as the moist crepitating
rale of Lsennec, such as simulates rubbing of the hair between
the fingers, and belongs emphatically to the air-cells and
bronchioles. It has been regarded as pathognomonic of pneu-
monia, and is heard in the first and third stages of the disease.
The significance is, that the alveoli contain both air and fluid.
There is a point to be made in the regularity of the rales, as
an irregular crepitating rale may be found in connection with
condensation, — the rale coming from the smaller bronchi
when the alveoli are impervious to air ; this crepitation is not
usually affected by coughing, as the contents of the alveoli are
not thus dislodged. It should be remembered that the medi-
um-sized and the larger rales, which are always more distinct
82 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
and louder than the smaller rales, are associated with the sim-
ple and primary of the bronchi, and yet their chief import-
ance in diagnosis consists in their being a frequent accompani-
ment of secondary catarrh which is allied with parenchymal
diseases of the lungs and with cavities. The rales themselves
are not of a character to enable one to decide upun the ques-
tion of condensation, but percussion and the character of the
respirations, presumably will so far aid as to leave little doubt.
The rales of a secondary catarrh which would be likely to be
associated with caseous condensation however, are likely to be
quite limited in distribution. Then as a rule they are of the
medium size coming from the smaller bronchi and are not
often appreciated by the hand.
Resonant and Non-resonant Rales. — Resonant rales are
always associated with condensation and cavities, while with
a spongy texture the rales will always be non-resonant. The
cause is apparent ; the dense structure favors the transmission
of sound to the superfices, while the resonant quality is lost in
passing through any considerable amount of lung expanded
with air. It is not a fact, however, that all condensation yields
us the resonant rale — should the dense part of the lung be ex-
ceedingly limited then the lesion would be surrounded by lung
substance still admitting air, and this would destroy the reso-
nance. The most pronounced resonance comes from cavities
situated superficially and near the thoracic walls, as these
rales will be nearer the ear and more removed from tissue
which deadens the resonance by containing air. In other
words resonance is increased by proximity to the walls and
the degree of condensation of lung tissue.
Creaking Sounds. — We have creaking sounds associated
chiefly with cheesy condensation of the apices which are valu-
able to study. They are never heard except when the secre-
tion is scanty, and then these sounds seem close to the ear.
They are often observed for awhile, then disappear — perhaps
on account of the bronchial secretion being arrested. Other
means of determining the condensation, such as percussion
and observing the character of the respiration, will be applied
if these creaking rales are detected, for they might be found
associated with a primary bronchial catarrh after all.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 63
Metallic Rales. — The ringing metallic rales are the most
.musical and accurate in pitch of all tones given out from the
chest; they are best imitated by letting drops of water fall upon
the bottom of a metallic vessel — they are always found in con-
nection with cavities of considerable size and near the thoracic
walls — precisely the same conditions which afford us the me-
tallic percussion sound and the amphoric respiratory murmur.
Auscultation of the Voice. — Auscultation of the voice is
employed to supplement or corroborate opinions formed from
auscultation of the respiratory murmur and percussion ; the
sounds are classified as bronchophony and egophony. Bron-
chophony is a normal sound in the larynx, but when found in
the chest it invariably points to condensation or a large cavity
in solid walls. By far the most common causes' of condensa-
tion, as has been stated, result from caseous exudation and he-
patization. In cavities formed from cheesy degeneration the
bronchophony is more intense usually than when we have
dilatation of the bronchial tubes. Gangrenous cavities rarely
obtain to sufficient size to yield this phenomenon. In large
cavities following caseous degeneration, there is frequently a
metallic ringing character to the voice sounds — it is not so
loud, however, as that which attends coughing.
Phthisical patients so far advanced as to have bronchophony,
are usually weak, and the voice is also weak and perhaps hoarse
and feeble from laryngeal complications: these conditions mo-
dify the voice sounds coming from cavities as would be ex-
pected. Bronchial respiration and bronchophony arise from
the same conditions and are always found associated ; they are,
however, of unequal intensity. Lsennec designated the more
exaggerated sounds in bronchophony, pectoriloquy, it is a
term of no particular significance. Skoda speaks of faint and
loud bronchophony, the loud being merely Laennec's pectori-
loquy. As we have said, bronchophony is more distinct in
cavities; yet infiltration under some circumstances yields quite
as pronounced a sound.
Baccelli has shown that the more fluid and homogeneous the
effusion, the more readily and thoroughly will it be j)enetrated
with the vocal vibrations, and that if circumstances favor, even
64 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
a whisper will become audible through the effusion; while
through fibrinous and purulent effusions the wave sounds pass
with difficulty or not at all; hence it is claimed that it is quite
possible to decide by the whisper whether it be serous, fibri-
nous or purulent matter through which the vibrations are
transmitted. It is advised that one ear be pressed firmly
against the walls when we are to explore, while the other ear
is stopped by the finger, and than that the patient turn his
face from the auscultator and speak either loud, or in a whisper,
Aegophony. — This term is applied to a sound which has
the peculiar tremulous character thought to resemble the bleat-
ing of the goat. The sound produced by speaking against a
comb covered with paper, or the twang heard when speaking
with the nostrils closed, gives a very fair conception of the
Aegophony is produced, as it is thought, by the vibration of
the walls of flattened or compressed bronchi; the voice vibra-
tions being transmitted to a thin layer of fluid lying between
the chest- wall and the lung; — moderate pleuritic exudation
would give such a pathological condition. It occurs, according
to Skoda, also in the absence of fluid, as it has been heard in
cases of exudative hepatic pneumonia and in caseous conden-
sation with and without cavities. It is not unusual to find bron-
chophony and aegophony at the same points or not far re-
moved. After all the aegophony may be considered as only
a modification of a bronchophony.
The lungs may be extensively infiltrated with miliary tuber-
cle and the sputa not be different from that in a bronchitis,
because in the early stages the irritation only provokes an in-
creased catarrhal secretion. Sometimes, however, before the
disease has had a continuance sufficient for anything which
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 65
looks to suppurative action, the microscope reveals the exist-
ence of elastic fibres, which is conclusive evidence of destruc-
tive wastes in the parenchyma, even if physical signs fail to
detect condensation or tubercular degeneration. The presence
of pulmonary epithelium, at one time, was looked upon as
diagnostic of that form of phthisis which is usually designated
as a desquamative pneumonia, but it is now known that epi-
thelium of this character has been detected in the sputum
which attends an attack of simple catarrh. The quantity of
sputa ejected depends largely upon the extent and severity of
the irritation, and in caseous degeneration the irritation is
usually progressive, the sputa being scanty in the outset and
very abundant in the latter stages of degradation. Should the
disease be arrested temporarily even, the expectoration would
also be arrested, and be very definitely modified by the pro-
gress of the disease. Sometimes we have blood-stains and
blood-streaks — hardly will these be diffuse; if these exist for
any considerable time it is extremely suggestive of caseous in-
filtration, and should be accepted as good evidence, even if the
physical signs usually attendant are not detected. Prolonged
expiration especially should be watched for as a corroborative
sign, available even before auscultation and percussion in
diagnosis. The sputum of cavities at once takes such peculiar
character as admits of no mistake; it is of firm consistence?
rounded in shape, of a dirty greenish or grayish color, and
sinks, in water; possibly there might be blood mixed with the
expectorated mass. There will be a quantity of mucus also
contained in the sputum, as the mucous membranes will keep
up their secretions as before the cavity formed. It is even
quite possible that the quantity of mucus may be in such pro-
portions as to hold up the purulent portion in water, because
of the quantity of air-bubbles confined in the expectorated
matters. Cavernous sputa examined with the microscope re-
veal pus-cells, free nuclei, elastic fibres and other debris of the
destructive process. Should the sputa from any cause be re-
tained for any considerable time in the cavities, changes most
likely would occur, tending toward a septic nature, and fer-
mentation would break down more 01 less the cohesiveness,
66 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
and an offensive odor would follow, the sputa taking on a
muddy, dull color.
Putrefaction in tubercular cavities, however, is much more
rare than in bronchiectatic cavities, as the cavities from tuber-
cle usually are more superficial and in the upper lobes, while
bronchial dilatation is usually in the smaller bronchi, and sit-
uated in the lower lobes, making expectoration more difficult.
Septic degradation in bronchitis with dilatative and gan-
grenous destruction of the lung-tissue, presents about the same
quality of sputa ; it differs in both cases from cavernous sputa
arising from tuberculous action ; in that it contains few or no
elastic fibres; evidently there is an element in the sputa which
chemically destroys the elastic fibre. Though the sputa of
tubercular cavities has not the tendency to putrefactive degra-
dation that exists in bronchiectosis and some kinds of inflam-
mation of the parenchymatous tissue, such as sometimes follows
pneumonia, or such as comes from inhaling poisonous vapors
and from causes which debilitate and degrade the blood, yet
we must regard that septicemic influences have not a little to
do with the fatality of phthisis. The study of the sputa then
is valuable for the purpose of following the progressive advance
of the tubercular transformation.
Then we may classify the expectorated matter into mucous
sputum, which consists of the normal elements of the secret-
ing mucous glands, mucous, water, and albumen in small quan-
tities, albumen always abundant when inflamniatory action
sets in; muco-purulent sputum, which contains pus cells in
addition ; and the purulent sputum which closely resembles the
pus discharged from an abscess. These constitute the base
constituents of all sputa. If blood be mixed it may be called
sanguiniolent, to indicate such fact, though blood constitutes
but a small part of the elements — more proper would it be to
say sanguinio-purulent or sanguinio-albuminous.
Gangrenous sputum is somewhat distinct, especially in odor
and possibly the addition of parasites, though probably these
are accidental and not elementary. The appearance however,
is different. The sputum is usually thin and abundant, of
brownish or dirty green, or yellowish-green color, and sepa-
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 67
rates into three strata on standing; the upper layer is frothy,
opaque and greenish; the middle is of a glairy albuminous
character, even almost a serous matter, while the bottom is
yellowish opaque matter, composed of pus corpuscles and a
detritus forming yellowish-white cores which are very fetid,
in which are found needle-shaped crystals of fatty acids. Gan-
grenous sputum rarely comes from tubercular cavities. Dilated
bronchi, emphysematous cavities and degradation of tissue,
blood thrombus, or burrowing abscesses formed from inhaling
sewer gas or other noxious agents, are the more common
causes of this sputum; it follows also from breaking down of
the lung tissue in the third stage of pneumonia. Elastic fibres
and blood stains, frequently appearing, then, may be regarded
as of great importance to note, as they are found early, often
before other physical signs can be made available for a diag-
nosis; they are very significant and appear at a time when
remedial agents and proper regimen promise most for our pa-
tients. The sputum indicating progressive destructive wastes
later on may still be studied for the purpose of selecting the
proper remedy, the extent of the pathological lesion and prog-
nosis; though the last by most will be thought to be a very
IMPORTANCE OF EARLY RECOGNITION OF
As a morbific influence phthisis often proceeds far along in
the work of disintegration of molecules if not of structure,
before tubercular deposit follows ; although tubercular deposit
is almost a constant concomitant in the retrograde movement.
Great emaciation, extreme nervous irritability and motor in-
capacity are often reached with little, if any deposit of tubercle.
We cannot be too much on the alert for the first expression of
vital deterioration, and retrograde tendencies in morphological
movements. The arrest of these early vital and molecular
68 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
movements which tend to locate a morbid focus in the lungs,
should be our first and chief care. It is not necessary to wait
till anscultation and percussion reveal the indications of tuber-
cular deposit before we are able to say whether there be steps
taken in the phthisical dyscrasia toward degradation of vital
force and the plasma. Indeed we may have tubercle in the
lungs, and the expert in physical diagnosis fail to detect such
a condition ; but in saying this we do not wish to underrate
the value of physical exploration in this disease.
Among the earlier and perhaps the symptom of first im-
portance is weariness. Patient says, I wish I could once get
rested; feels too feeble for doing anything; particularly wearied
and out of breath on going up hill or up stairs. At this stage
may also be noticed the delay in expiration while breathing ;
the expiration being relatively longer than the inspiration.
Then follows the constantly increasing muscular attenuation
the liability to take cold, the short, dry, hacking cough, the
complexion showing that the coloring matter of the blood is
also diminishing, for this pallor comes in the early stages
almost uniformly. If your patient is connected with a phthi-
sical family, these symptoms are all the more significant. If
they come from any unexplainable source they are of the
gravest import. If they follow an anaemia or exhausting
draughts upon the constitution there is not a moment to
be lost. Whatever the antecedents the case has reached a
At this stage the appetite is likely to be capricious ; some
articles of food are taken with a relish, perhaps, while others
are loathed. In young girls suffering from menstrual disor-
ders, who have phthisical tendencies, especially is this the
case. In not a few, there seems to be a dislike of fatty foods ;
perhaps they will relish butter and dislike other fats. Then
there is a class who eat well but constantly lose flesh. They
are nervous, irritable and apprehensive ; a condition of mind
in exact contrast to what is seen at a later stage of the disease.
Activity of Mind. — DaCosta and others remark upon the
great brilliancy of the mental faculties, and some mention it
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 69
as a premonitory symptom. Our observation is, that very
promising persons as to their mental gifts, often fall a prey to
this disease, and we remember cases where this mental activity
seemed to precede by a few months, well declared symptoms of
phthisis. If the symptom found corroboration in family his-
tory, or by other prodromic symptoms, we would attach much
importance to it.
Hoarseness. — We have noticed that many of our cases
treated for aphonia died later of pulmonary phthisis ; some-
times not for years, however. Hoarseness may be looked upon
with suspicion when it is chronic, or when repeatedly occur-
ring in persons of delicate health ; especially if they have ob-
stinate catarrhal attacks with coughs which are difficult to get
rid of. No doubt chronic laryngitis is often suggestive of in-
cipient tuberculization of the lungs. According to Cohen
and other laryngoscopists, even tubercle is often detected in
the larynx before physical examination shows any invasion
of the lungs.
Cough. — A cough is often the first thing which attracts at-
tention ; it is much more constant than hoarseness and may
exist for many years, but never loses any of its significance.
It is usually a dry irritative cough, sometimes of a loud bark-
ing or explosive character. Possibly it may be only a mere
hack with an inclination to clear the throat of some viscid
secretion. At this time it is doubtful if it be more than a
catarrh where the walls are only a little thickened ; but we all
know the significance of a catarrh, especially when lodged in a
Temperature. — Temperature is of very great value in rapidly
developing phthisis, as an early symptom, it is of less value in
very slowly developing cases of phthisis. Prof. Flint says :
"Increase of the temperature is evidence for, and absence of
any increase, is evidence against the existence of the disease."
Usually, and perhaps always, there will be found periods of in-
crease of temperature, before physical signs indicate tubercle ;
and, as has been stated, these vary as to the time of appear-
. ance and in the degree of fever expressed. If the temperature
be high it indicates rapidity of disease, extensive tubercular
invasion and early softening of tubercle. It is important to
70 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
take the temperature night and morning, and for a week or
two, if we would have much value attach to this symptom.
The morning temperature may even be higher than the even-
ing, which would be an exception, and this fact can only be
known by a comparison. The temperature may vary one day
with another, and this can only be determined by taking the
temperature sufficiently long, to get at an average; and the
remission of the fever itself, may be important if found. If
the temperature taken in the axilla is maintained as high as
99° for a few weeks, it is indicative of tubercular troubles; and
if it is supported by other symptoms or occurs in a constitution
seemingly predisposed to consumption there is reason for grave
SUGGESTIONS FOR MANAGEMENT.
The whole regimen needs prompt attention, the totality of
symptoms need careful study, the proper remedy needs to be
selected and judiciously given. It may be Phosphorus, it may
be Sulphur, or it may be Zincum, or some other remedy more
fully covering the symptoms. Good air, good food, warm
clothing, plenty of sunlight and plenty of sleep are now in-
dispensable. And yet, the homoeopathic agent, taking the
rank of the similimum, is our lever and the great thing on
which to rely. No morbid element or factor can be over-
looked. Mastery of the totality of symptoms must be made
if we expect any success; not the outward symptoms alone, or
chiefly, but the dyscrasia, the radix, and the most occult
vital impediment. It is of much less importance in a thera-
peutical sense to determine the location of a vomica than to
differentiate and classify the objective and subjective symp-
toms concerning the cough, sputa, complexion, aggravations,
ameliorations, etc., so as to be able to give a remedy which
shall so act upon the vital movements as to arrest this retro-
grade process. Well as it may be for one to be skilful in all
the methods of physical exploration, this other study of vital
expression is indispensable. Certain it is, there is no excuse
at this day for a man's being ignorant in our methods of phy-
sical diagnosis. If he cannot tell, as a rule, if he have tuber-
cular dulness, bronchophony, aegophony, or pectoriloquy, he is
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 71
not to be commended for his learning, and yet there are
weightier matters; yet, it may be doubted if one knows noth-
ing of physical diagnosis, if he will be a very good diagnosti-
cian on higher grounds. We must know it all, pathology is a
part of the totality of conditions, and is not to be separated
from the symptoms. The first step in a large class of our cases
will be to eradicate the constitutional dyscrasia, or to eliminate
from the system such impedimenta as put progressive vital
movements under arrest. This dyscrasia, no doubt, is what
Hahnemann would often express as a psora, having a much
broader significance than scabies or its family implied in the
term. Faulty assimilation, and faulty excretion, are to be at-
tended to, and faulty excretion may often be the antecedent of
faulty nutritive preparation and assimilation. All impedi-
menta tend to functional inertia, and functional inertia to low
grades of vital activity or poor health, the earlier retrograde
steps to the later and more serious disintegrations. Then,
attack the tubercular dyscrasia, the psoric-dyscrasia, or the
hydrogenoid-diatheses, or whatever name be given to it, in its
most latent form ; acting upon the principle of tubercular pre-
vention as the first duty of the physician. Outside of thera-
peutical prescriptions, much may be done in grading our vital
status up by proper choice in marriage alliances, a matter for
every well-wisher to his household to think of, and for students
of sociology to study. Tuberculosis on both sides will surely
bring death to offspring. Training for muscular development,
which antagonizes somewhat the tubercular diathesis, is another
way of overcoming danger. Muscular development and ac-
tivity divert fibrin from the overcharged vessels in the lungs,
and relieve the damming up process so favorable to tubercular
exudation. Too much brain work must not be put upon grow-
ing persons, or even upon older persons with tubercular ten-
dencies. Free expansion of the lungs and liberal activity of
the muscles clear the stasis in the capillary and venous vessels,
and the oxygenoid processes will go on more completely, work-
ing up fibrin to a condition adapted to structure building, and
separating the unallying and effete matters, and giving them
a current toward the eliminating channels. Abundance of
sun, air of a high electrical status, giving a dry atmosphere
72 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
instead of a moist, is an adjunct. A systematic practice of ex-
panding the lungs to their full capacity by the spirometer is of
considerable value, as by such efforts at keeping the air-cells
open, they are less likely to become the receptacles of cheesy
deposit. It is a noticeable fact that tubercle has a facile
tendency to infiltrate into the tissues of the apex of the lungs,
and may not this be explained largely upon the generally
feebler expansion of the cells at the apices?
Comprehensively, reserve force is to be carefully economized,
and so far as may be built up and accumulated, while over-
work and every devitalizing influence is to be avoided.
DIFFERENT CAUSES SUGGEST DIFFERENT
Whether we are to alter our opinions upon the nature and
curability of that disease which has from time immemorial
been the scourge of our race and the opprobrium of the pro-
fession, in the advancing light of science, is a question which
our moral courage should permit us at least to consider. Pos-
sibly we have emphasized the difficulties of the situation from
taking our data too much from one class of cases, and that the
worst class. Autopsies reveal more cures, or arrest of advance
at least, in descending transformations, than had been sup-
posed to exist. Have we given sufficient scope to our investi-
gation of causes? Indeed, have we not laid too much stress
upon hereditary transmission of the disease we call phthisis,
and overlooked the accidents of arrest of nutrition and elimi-
nation, particularly the last? Suffice to say, that it seems to
us that the causes of phthisis are various, and possibly the
pathology may yet have to undergo a revision. Any foreign
substance acting as an irritant to the lungs may finally end in
destruction of tissue and the degradation possibly may take
the course of caseous exudation. We once knew a young man
who by accident drew into the air-passages a portion of the
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 73
husk of a beech-nut; it lodged at the bronchial bifurcation,
provoking a violent cough for two years or more, and slight
hemorrhage at times. At length it was coughed up, but it
had provoked tubercular deposit, of which he died within the
year. There might have been some slight predisposition to
tubercle, but inflammations cause infiltrations of fibrin or fib-
rinoid matter into the lungs, and this has a tendency to un-
dergo degrading transformations and open up pus receptacles
to be followed by all the results of retrograde metamorphosis.
It is hardly denied that tubercle is a constant accompani-
ment of phthisis proper, but this tubercle possibly may be an
incident of the disease. We are almost inclined to think we
can have a nervous phthisis, no tubercle existing till the
phthisis has been long set up. We dare not deny death may
occur before the stage of deposit. We find a large per cent.
of consumptives in districts where many of the inhabitants
are confined in manufacturing establishments, breathing the
dust of mills, much of it dust from cotton and woolen fabrics.
Probably such a life meets more often the extremes of heat
and cold, which of course tends to congestions and disturb-
ances in the vascular vessels. Pneumonias follow, possibly
tubercle even in good constitutions.
What we breathe into our lungs, no doubt has much to do
with their soundness. Indeed, we may say that this is no
longer a question, pathological study having fully settled the
fact. An eminent student of pathology has declared that the
number found with affected lungs is surprising, and that in-
haled particles of dust of one fabric and another is clearly the
cause of the largest per cent, of all diseases, and especially of
consumption. A climate subject to extreme changes is a very
common cause no doubt, as congestions, catarrhs and pneumo-
nias, are often the admitted antecedents of consumption. We
have kept the record of a large neighborhood in a town of
New England for over forty years, and, to our surprise, more
of its citizens have died of consumption than all other diseases
put together. The neighborhood is located upon a plateau of
high land sloping southeasterly for the most part, and the bal-
ance occupying a basin at the foot of a mountain range — the
74 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
stream flowing south through the valley. We do not suppose
this is exceptional. Several cases did not seem to trace to any-
hereditary predisposition. In one instance the person had been
attacked several times with pneumonia and did not die till
past fifty ; a brother died of pneumonia not far from fifty-five ;
the parents died quite old; several sisters and a brother are
living now and quite along in years. Still another case, that
of a young lady, set. about twenty-one; she had hemoptysis
and died within a year and a half; father died of fever and
mother lived to be very aged. Three brothers and three sis-
ters, most of whom are living yet, never showed the least trace
of tubercular troubles, and these cases can be duplicated in
the same neighborhood. In another family one daughter and
three sons died of consumption, while one daughter escapes
so far; and a son nearly sixty is living, but has a bronchial
trouble of a serious nature. The father and mother both lived
up to eighty or more years. At the time the children were
being carried in utero the mother was intemperate as well as
the father. Consumption afflicts the second generation in this
line in two families, that of the eldest son who died at about
fifty years, and the second son who died a little younger. The
third son who died even earlier in life had no family so far as
known. It looks very much here as if alcoholism was able to
so far vitiate the evolutionary force as to insure early retro-
grade metamorphosis, which in this case took the course of
caseous degeneration of the lungs, and also carried a heredi-
tary bias with it. We have known thoroughly the history of
several cases in different localities where syphilis had been
contracted, that ended in pulmonary consumption with syphi-
lization and tubercularization conjoined, and part of them did
not seem to have any particular predisposition to phthisis ;
one case, that of a woman, who was one of a family of eleven
children, parents living to be seventy-one and seventy-eight.
The other children are still vigorous, many of them well along
We have known other cases where gonorrhoea developed a
phthisis out of its own root, or provoked germs of scrofulosis
quite too latent to be recognizable by any symptoms or his-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 75
torical proofs in family genealogy. We do not say that such
cases follow the identical course of a scrofulous phthisis, but
they end with pathological lesions, and other phenomena so
thoroughly alike that we are unable to draw the lines at least.
Rindfleisch would say, these were stimuli to latent infections.
A phthisis developing out of a syphilitic taint, is apt to be
slower in progress in the second and third stages, we should
say, than a phthisis developed from scrofula per se. Some
may doubt if such cases should be called pulmonary phthisis;
well, we have tubercular degeneration and cavities. We say
that a phthisis developing out of a pneumonitis is not a phthisis
direct, but we have tubercle and cavities, and the same septi-
csemic influences followed by death. The beginning is differ-
ent but the end the same. This is the point we are laboring
to show. A case is not studied in its totality till every element
is also well studied. Hahnemann studied thus the totality of
the constitutional morbific forces.
Experience must determine how far Aurum muriaticum,
Kali hydriodicum and Nitric acid can be made to aid in the
restoration of the vital forces in a phthisis pulmonalis with a
syphilitic antecedent. We have no doubt but that these agents
in such cases will be much more frequently indicated than
Phosphorus, which is so efficient in cases arising from pneu-
monitis, or than Sulphur, so widely applicable to many forms
of chronic disease, especially the catarrhal and those arising
from faulty elimination. In cases where measles, or any other
eruptive disease seems to be the provoking cause, we need to
study the case by giving due importance to the unknown
morbific force which was declared first in the rubeola, or
variola as it may be; and what is known in therapeutics as
corrective of these morbific forces may find a further adapta-
bility in the degradation whose focus is the lungs. So of gon-
orrhoea we may look for Mercurius or Thuja to serve beyond
other remedies in the tubercular complication. We do not
say that generalization shall take the place of symptomatology,
that we are not to give the best indicated remedy from the
standpoint of subjective and objective symptoms, especially
the first, these being the highest in rank. But very likely our
76 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
case will agree in this totality, and possibly subjective symp-
toms will be very deficient. If our course of reasoning is
correct, it is easy to see that no one remedy can be a panacea
for tuberculosis of the lungs; cod liver oil, phosphate of lime
and soda, or anything else. Each case must be individualized
and treated in its totality. Treating our cases by including
the totality of the symptoms, the history and pathology being
a part of that totality, we should naturally conclude that cases
arising from different causes and with different phenomenal
progress, would require different remedies for treatment. To
instance another class of cases, consumption dating its begin-
ning from a malarial poison, would more naturally suggest
Arsenicum, Lycopodium, or Natrum muriaticum, than Stan-
num or Sulphur, and presumably the out-cropping phenomena
would better correspond to the provings of these remedies.
For the more purely scrofulous cases, with faulty nutrition
and glandular obstructions, to meet temperamental defects and
hereditary bias, those agents used for the removal of the deepest
chronic dyscrasias will naturally suggest themselves. With
this interpretation of phthisis the element of hereditary trans-
mission will not attach in all cases, although the law of nature
which tends to a perpetuation of types is admitted. Consump-
tion thus studied and thus treated, we apprehend, will prove
the triumphs of science instead of standing a perpetual oppro-
brium upon our art.
AMENORRHEA, OVARITIS AND ENDOMETRITIS
AS CAUSES OF PHTHISIS.
The non-appearance of the menses at the age of puberty
has its cause usually in some cachexia; such faults of second
assimilation as show themselves in rachitis, chlorosis and scro-
fulosis very likely may be at' the bottom of the difficulty. In
some cases the ovaries degenerate and become atrophied; very
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 77
often the amenorrhoea is associated with a general ansemia;
there are associated with these cases as a cause or as a com-
plication, chronic infarctions of the womb and oviducts, the
result of catarrh or a uterine lymphangitis. These troubles
need to be successfully treated to save invasion of the lungs in
the end. It has been ascertained that the spontaneous move-
ments of the white blood corpuscles are dependent upon the
oxygen imparted to them from the red corpuscles. In chloro-
sis the red corpuscles are rapidly depreciated, and the oxygen
bearing capacity is greatly reduced. It is fair to suppose that
as the spontaneous movement of the white corpuscles ceases,
they will impact in the minute capillaries. And as the apices
of the lungs present a favorable point for" the lodgment of
such corpuscles, possibly we may get cheesy exudation in this
manner. We have often noticed how quickly the lungs become
attacked from certain forms of amenorrhoea ; of late years also
we have had occasion to note how very frequently cases of
pulmonary phthisis followed the treatment of uterine catarrh
by astringents and cauteries. No doubt some of these cases
have a scrofulous groundwork at the beginning; if so, all the
more important that the treatment should be constitutional
and not local. The scrofulous element is less dangerous act-
ing as a uterine lymphangitis than as a tubercular attack of
the lungs, and there is no doubt but that there is danger of
metastasis from such treatment. Perhaps it is only fair to say
that such treatment is likely to convert a rnild form of lym-
phangitis into an intractable one, and that such intractable
catarrh tends to break down the nervous system, impair the
digestion, and bring on such debility and blood degradation
as paves the way to a phthisis. I fear untold harm is being
done by such pernicious treatment of our cases of uterine lym-
phangitis and chronic catarrh. Then if we are not greatly
mistaken, the indiscriminate use of iron in large doses for
amenorrhoea and chlorosis has only tended to aggravate the
difficulties for which it has been given, and all the more cer-
tainly to bring on tubercular complications. So strong are
our convictions of a need of reformation here, that I have
deemed it proper to devote a few pages to an analysis of the
78 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
leading remedies which experience has shown to possess a
curative value in this class of cases.
Alumina. — The anaemic state to which Alumina so well cor-
responds, makes it a remedy suitable for chlorosis, and other
conditions, where the menstrual function is deranged in a way
to threaten pulmonary complications. The menses delay or are
absent, color pale, quantity very scanty; leucorrhoea: acrid, pro-
fuse, and light colored ; usually alleviated by cold washing. There
are throbbing pains in the vagina upon the left side ; stitches in the
vulva upon the left side, extending by sympathy into the chest. If
the lungs become implicated, the cough is dry and hacking ;
worse from talking or singing, often causing pain in the right
temple or on top of the head. There is an oppressive pain which
is worse at night; often stitches in the chest from right to left
(Lycopod.), in the afternoon — hoarseness or aphonia, and if any-
thing is expectorated, feels as if torn away and after tedious cough-
ing. Alumina patients are apt to wake with palpitation of the
heart — often have to strain a great deal in voiding urine; pass it
best when at stool; sometimes contrariwise, cannot cough with-
out involuntary urination ; possibly have pain in the back as
if a hot iron were being run through it; agrees with thin dry
people and women greatly prostrated by menstruating. Ap-
petite is perverted, wanting chalk, charcoal, cloves, tea-grounds or
some indigestible and unnatural substance. Aggravations on al-
ternate days; after dinner, when in out-of-door cold air, also
from using wine, vinegar, salt and pepper.
Apium virus. — Will be found an important remedy when
the morbid expression commences in the right ovary and de-
velopes lung symptoms.
The right ovary is swollen, painful, with pains passing down
the thigh, or with soreness in the upper portion of left lung,
attended with a cough. The pain may extend up to the ribs
on the right side from the ovar}' - . There is often a numb feel-
ing in the side or down the thigh ; the urine is apt to be scanty;
• the stool scanty and difficult, or possibly a diarrhoea of a wa-
tery character and foul smelling.
Accompanying symptoms are: menorrhagia with faintness;
suppression of the menses; amenorrhcea; dysmenorrhea; leu-
corrhoea which is profuse, acrid and green.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 79
Calcarea carb. — Those who have been broken down by
frequent and too profuse menstruation, or by frequent miscarriages,
or too rapid child-bearing, will often be benefited by Calcarea
carb. Patients are easily out of breath on going up stairs,
have to sit down, they are so much fatigued and out of breath;
they catch cold easily; have damp feet; do not sleep much after 3
A.M.; are often troubled with watery whitish diarrhoea; a leu-
corrhoea like milk ; cervical glands swell ; skin is flabby and
soft; pains are aggravated by the slightest touch or noise;
cough is dry at first with profuse salty sputum later. The
later symptoms with advancing phthisis will be found under
the heading of Calc. carb. in a subsequent chapter.
Guernsey gives the symptom, "least excitement causes the
menses to return." Marcy and Hunt, "albuminous leucorrhoea,
from the cervical canal, with great lassitude, debility, sinking,
and trembling at the pit of the stomach, and burning pains
in cervical canal." Dunham says : " The menses occur too
early and are too copious often in incipient phthisis." Also
that the leucorrhoea is apt to be " worse before the menses."
Conium mac. — The action of Conium upon the glandular
system, and upon the genitive system of woman, suggests its
adaptability to morbid states which have a tubercular tendency.
The symptom, pain shooting into the left chest when dysmen-
orrhoea exists, shows a tendency of the lungs to sympathize
with uterine troubles. We have inflammations of the ovaries
and mammae, enlargement of the ovaries and nodes in the
breasts amenable to the action of Conium. Mammae are sensi-
tive before menstruation. Then again mammae shrink away
while the sexual appetite is active. Pains in the uterus are
stinging in the neck and aching in the fundus. Stitches in
the vulva is another symptom of Conium. Harley recom-
mends it for exhaustion of the sexual organs. It is adapted
to scrofulous persons of a rigid fibre. Hughes gives the symp-
tom, "hacking, almost continual, cough; worse at night, when
lying down." Hering, "hard cough, excited by itching or
tickling in throat and chest, also bloody sputa, purulent sputa,
sputa of putrid taste and smell. A remedy for single women
along in years and light-haired persons."
80 PHTHISIS PULMONALISI TUBERCULAR PHTHISIS.
It would seem to be best indicated for such cases as tend to
atrophy or indurations ot the ovaries or mammae, consequently
showing a degree of arrest of the reproductive functions, and
for such as have dysmenorrhea, with pains in the lungs, or
hemoptysis. Also to a spasmodic cough which is worse even-
ings and when lying down. The cough is provoked by tick-
ling or itching in the chest or throat.
Ferrum met. — I am sure that the use of iron in large doses
often excites the vessels of the lungs to tubercular activity. I
have personally observed the fact under circumstances not ad-
miting of doubt — and if large doses of iron will occasion the
exudation of tubercle, why may not the infinitessimal arrest the
morbid activity which developes tubercle? I think we might
find the use of Ferrum in the 30th attenuation upward a very
valuable remedy in certain cases of phthisis. I do not think
it is worth anything below that any more than Sulphur, and I
have seen astonishing results from the 100 m. of Sulphur when
the 30th had apparently no effect.
For hemoptysis from suppressed menses I think we have
no better remedy, it being understood always that the simili-
mum is the remedy par excellence. In Ferrum hemoptysis the
blood is usually bright colored, readily coagulates, and not un-
frequently it is accompanied with interscapular pains; some-
times there are flying pains in the chest; pulse is rapid, breath
short, and hands tremble; countenance either pale, greenish-
pale, or pale with spots; the sputum in advanced cases of lung
trouble is copious, putrid and purulent, or greenish and frothy
with purulent globules intermixed. Patient raises most in the
morning and when moving about ; is troubled to raise at
night, unless she sits up in bed. Guernsey gives the symp-
toms : " Weakly persons, with fiery-red face." " Least motion
or exertion produces a red, flushed face." "Anaemia, with pale
face and lips, with great debility." " Face becomes suddenly
fiery-red, with vertigo; ringing in the ears; great palpitation
of the heart and dyspnoea." "Vomiting of food, with fiery-
red face; vomiting of ingesta after every cough." "Previous
to menses, has stinging headache, ringing in the ears, and dis-
charges of long pieces of mucus from the uterus." " Leucor-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 81
rhoea like watery milk, smarting and corroding the parts when
first appearing." " Menorrhagia in weakly persons, with fiery-
red face. It occurs too frequently, is too profuse, and lasts too
long." " The menses intermit two or three days, and then re-
turn, the blood being very pale." "Hemoptysis, and spitting
of blood" are mentioned by both Guernsey and Hering. Lippe
speaks of a "general hemorrhagic tendency." The tempera-
ment and concomitant symptoms corresponding to Calc. carb.
and Ferrum it will be seen are very unlike, though the exces-
sive menstrual flow is quite alike.
Iodium. — From its influence upon the glands, both large and
small, we might naturally suppose that Iodium would find a
place in the treatment of ovarian troubles and also in dis-
eased lymphatics, whereby the products of nutrition are lim-
ited. Admitting that tubercular products are the result of a
lymphangitis as some seem to think, it is no strange move of
the morbific force acting upon the glands of the genital system
of a woman, to set up also a morbid seat upon the mucous glands
of the respiratory tract. Iodium seems called for in persons of
low cachectic condition of the system; such as arises chiefly
from scrofula. Persons incline to emaciate, even while eating
well. The mammas dwindle in particular, are sensitive and
sore. Women of this habit either menstruate excessively or
not at all. If amenorrhcea exists they are very apt to show
tubercular troubles of the lungs in a short time. The pulse is
rapid, and there are other indications of pulmonary troubles,
such as out of breath from little exercise, and an unexplainable
weakness and languor is felt.
Further uterine symptoms are, acrid leucorrhcea, more pro-
nounced just after the menses, so acrid as to perforate the linen.
The right ovary is more often the seat of trouble. Iodium pa-
tients are usually very restless and want constantly to change
their position (as in Rhus). Troubled also with canine hunger,
eating very frequently. Their hunger may alternate with loss
Iodium patients are liable to pulmonary hemorrhages and
congestions. Have the sensation of weakness in the chest, as
in Stannum, but less marked; also sharp, quick, piercing pains.
82 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
Cough more frequently a dry morning cough, with tickling in
the larynx or burning in the thorax. Expectoration saltish, or
sourish in taste — gray or white in color. Also large quanti-
ties of mucus streaked with blood have been observed. Voice
is hoarse and larynx sore.
Guernsey speaks of empty eructations and a saltish taste in
the mouth. Hughes speaks of its use in constant inclination
to cough from tickling in the trachea and under the sternum,
with emaciation and wasting fever, rapid pulse and diarrhoea.
Lycopodium. — The action of Lycopodium upon che ovaries,
especially upon the right, has for a long time been well under-
stood. It. has been gaining clinical importance recently in
the treatment of consumption. The two facts suggest that we
are likely to find cases where it will be of great service when
lung troubles seem to have arisen from menstrual derange-
ments. The flatulency affecting the stomach and bowels; the
urinary sediments; transverse character of pains or affections
affecting the upper right and lower left sides, are often accom-
paniments pointing to Lycopodium. The leucorrhoea, if pres-
ent, is usually excoriating, bowels constipated. Patients are
subject to sharp, cutting pains in the limbs, are sensitive to
cold air, and are apt to emaciate, especially in the upper part of
the body. The cough often seems to come from the stomach which
is usually a sympathetic point; appetite is poor, or stomach
fills up quickly if one attempts to eat; pyrosis or burning at the
pit frequently exists as a complication. Expectoration is of
a grayish-yellow or greenish-yellow and purulent color, tasting
saltish. Cough worse evenings, or night and morning.
"A woman of lymphatic temperament has for a long time
suffered from a cough. Symptoms : cough getting worse, aggra-
vations morning and night, expectoration copious, yellowish-
green, purulent and of salty taste; occasional stitching pain in
the chest; very weak; night - sweats ; looks more and more
miserable every day; little appetite; burning at the stomach;
bowels constipated ; moving every 3 or 4 days ; excoriating fluor
albus ; cannot bear a current of air; shifting rheumatic pains;
had taken Nat. mur. and Calc. Gave Lycop. 30 every day, then
every two days; relief after the first dose, then improvement
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 83
in the cough, disappearance of the night-sweats, gradual lessen-
ing and eventual cure of leucorrhcea. Discharged cured in eight
weeks." — Krussler, in Allg. Horn. Zeitung, xxix., 122.
Dunham mentions the symptoms : "Menses too profuse, antici-
pate a little; preceded by flatulent distention of the abdomen;
great weariness of the legs; chill and heat at night; ill-humor
and disposition to weep. During the menses, acid taste, head-
ache, severe backache; swelling of the feet, nausea and a kind
of faintness. Leucorrhcea in spells; of a blood-red color."
Guernsey mentions "cutting pains across the body from
right to left."
Murex purp. — With the genital symptoms of Murex we
have pain going into the lungs, which indicates a strong sym-
pathy. It corresponds to that depression which often accom-
panies uterine diseases occurring in one naturally given to
cheerfulness and elasticity of spirits. The most noticeable symp-
toms are, strong sexual desire which is greatly intensified by
touch of the genitalia; pain in the right side of the uterus
going into the abdomen or thorax (pain often crosses the body
and ascends to left mamma) ; pain in the uterus as if cut by a
sharp instrument; throbbings in the uterus; menses, after
flowing a few days, stop and reappear after twelve hours.
Concomitant symptoms are, thick and greenish or watery
leucorrhcea; urine has an odor like valerian; great lassitude
and feebleness in the body and limbs as well as the mind;
" all gone " feeling in the pit of the stomach ; patient feels that
she has a womb, giving her great discomfort. It is well known
that many of our consumptives are given to strong amatory
desires; in such cases it would be well to consult Murex.
Pulsatilla. — There is a class of cases with blood-spitting or
pulmonary hemorrhage and severe coughs, which the physician
frequently meets with, arising from menstrual troubles, liable
to end in the gravest results to the lung-tissue, which call for
Pulsatilla. The mild tearful disposition; peevishness; flying
pains ; light complexion and blue eyes ; the chilliness even in
a warm room or whenever the bed-clothes are stirred, and yet
wanting the out-door air; the inclination to yawn; bitter taste
in the mouth after drink or food; thirstlessness, or thirst for ale
84 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
and spirits; aversion to milk and fat food; nightly aggrava-
tions; beginning of trouble after a menstrual excitement or
when the menses have been suppressed; perhaps before they
appear, are sufficiently indicative. Hysterical symptoms; op-
pression of the chest when walking up hill or going up stairs ;
irritation at the pit of the stomach which causes coughing, per-
haps vomiting, are frequent accompaniments. The blood,
if we have blood-spitting, is dark and usually coagulated.
Hering recommends Pulsatilla in phthisis florida occurring in
chlorotic girls, even when in the suppurative stage of tubercle.
"In one case Pulsatilla in repeated doses, cured a cough
with expectoration of blood, which had existed for three
months; the cough and blood-spitting having made their ap-
pearance after the cessation of the menstrual flow, and had
not yielded to any other remedy. The expectorated blood
was mostly dark, in coagula, mainly at night, the cough was
tormenting and constant all through the night, making sleep
impossible, with dyspnoea and stitches in the left side of the
chest; feet always cold. While using Pulsatilla both hands
became covered with herpes which disappeared again after,
several months." — Knorre, in Allg. Horn. Zeitung, v. 31 0.
Dunham sums up the leading uterine symptoms thus : " In
the hypogastric zone, drawing, pressing or constricting pains,
like labor pains, converging toward the pudenda. Pains re-
lieved by crouching forward. They come, generally, just before
the menstrual period, are attended by a feeling of weight, like
a stone, in the hypogastrium, and accompanied by chilliness,
stretching and yawning. The menses are delayed, difficult
and scanty, or even fail altogether. Stomach-ache and faint-
ings; aggravation in a warm room and by much exercise, and
better in the open air. Leucorrhoea of a thick mucus resem-
bling cream. Sometimes acrid, producing burning pain, some-
times bland, most profuse after menstruation."
Many aggravations of Pulsatilla are during menstruation.
"Morning cough." — Fincke.
Sepia. — Dr. Hitchman has reported a case cured by Sepia
of much interest.
Lady was set. 47, and a mother of several children ; had been
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 85
confined to her bed some weeks, and for a long time her peri-
odical secretion had not appeared until six weeks previous to
the doctor's visit, when" she had a flooding period of five weeks,
which, however, was arrested at time of being called. "On
investigation found she had felt a pain in the left side, under
the false ribs toward the back, of a cutting, digging nature; had a
cough; no appetite, and was very weak and badly emaciated;
suffered much with thirst and when she fell asleep perspired
profusely. Subsequent explorations revealed a tumor tending
to point at the spot where her pains had existed so long, and
physical signs were that of air in the cavity and gurgling
rales when coughing; at the end of ten days from first visit
pure pus was expectorated and afterward the tumor was less
pronounced. Various remedies were tried with only partial
success until into March; China, Kali carb., Lycopodium, Stan-
num, Pulsatilla among them." A few doses of Sepia at last
cured the case almost magically the doctor says. It is not
quite clear that tubercle played any part in this case, although
the doctor speaks of a decided tubercular diathesis induced
largely, as he thought, by mercury and other drugs, but there
is no doubt about the pulmonary abscess, and the great danger
to his patient from such abscess. The lady's courses became
well established as her recovery was completed. The doctor
mentions the symptom of cutting, bearing down pains in the
abdomen extending to the thighs as connected with her flood-
ing, which is the key-note to Sepia in this case.
" On the sexual organs of women Sepia acts very distinctly.
Along with cutting pains in the abdomen, a pressure is felt on
the uterus downward, as if everything would fall out. The
menses come too early (reverse of Pulsatilla), but are scanty.
They are preceded by violent aching in the abdomen, causing
even faintness, and by chilliness and shuddering. During
menses drawing pains, palpitation and dyspnoea, toothache,
headache and nosebleed. Frequent stitches in the vagina in
paroxysms, with or without a watery yet lavish leucorrhcea.
Leucorrhcea rarety acrid. Sepia produces (and cures) a dry
fatigueing cough, provoked by a sensation in the region of the
stomach as if cough come from there, or from the abdomen.
86 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Again, it has a cough with copious, saltish expectoration, white
or greyish-yellow. Stitches, faintness, nausea are accessory."
We have hardly more than indicated the methods of study
in this class of cases, not attempting in any sense to present a
complete list of remedies which will be indicated, nor even a
majority of such as will suggest themselves to any one as
likely to be needed. Kreosotum, a remedy resembling in
many ways Pulsatilla in its action upon the female organism,
Conium, Iodium and Sulphur are remedies likely to be indi-
cated as often as most of those receiving more extended notice,
but their indications are not difficult to be found in our
Materia Medicas when investigation is once directed in the
right direction. Sulphur especially is a remedy to consult for
many derangements of the female sexual system with a ten-
dency to lead up into phthisical troubles. A few leading in-
dications from Dunham will be a fitting close. " Menstruation
appears to come too soon, and to be increased in quantity.
Dry evening cough, colic, toothache and abdominal cramps
often precede. Menstruation is likewise delayed or suspended,
and this symptom, if accompanied by the night restlessness,
constipation and other symptoms characteristic of Sulphur, af-
fords a very valuable indication in practice. I have often used
it successfully where menstruation was suppressed, whether
by cold during a previous period, or by unknown causes and
where Pulsatilla had been given without effect. I think it
more frequently indicated in amenorrhoea than Pulsatilla."
HEMOPTYSIS: PULMONARY HEMORRHAGE.
Many cases of consumption come to us with the antecedent
of pulmonary hemorrhage; undoubtedly in many of these
cases tubercle may be the cause of the hemorrhage, but prob-
ably there are exceptions to this. Engorgement or congestion
may exist and the pressure upon the walls be too great, when
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 87
a hemoptysis will follow, no tubercle being present. But the
congestion and subsequent inflammatory action may favor the
exudation of tubercle, especially if there be a predisposition.
Prof. Watson says: "The complaint of which hemoptysis is by
far the most frequently symptomatic, is tubercular phthisis.
There are many persons in whom the first attack precedes
even for years the primary symptom of unequivocal phthisis;
there are others in whom the first attack of hemoptysis is im-
mediately followed by all the signs which announce the pres-
ence of tubercle in the lungs. Many again do not spit blood
until the tubercles have acquired considerable development
and the phthisical symptoms have been for some time clearly
marked." Audral says, of the persons whom he had known
to die of phthisis, one in six never spit blood at all ; three in
six did not spit blood until the existence of tubercles in the
lungs was already made certain by unequivocal symptoms; in
the other two-sixths, the hemorrhage preceded the other symp-
toms of tubercular disease and seemed to mark the period of
its commencement. This is a very large per cent., only one in
six escape by this author's observation. Our observation does
not give so high a per cent, however, but large enough to at-
tach the gravest consequences to a hemoptysis; and yet we
have learned to avoid usually fatal terminations following
hemoptysis. M. Louis gives the ratio as four to six. As far
back as the days of Cullen it was held that the spitting of
blood was often the cause of pulmonary consumption. The
significance of hemoptysis as bearing upon phthisis pulmona-
lis is spoken of in the following manner by Thomas Watson
in his London Lectures: "The occurrence of hemoptysis, con-
sidered in reference to the probable duration of life in those
who are subjects of it is of melancholy omen; if from any
given number of persons who have been known to spit blood
we subtract those in whom that symptom was connected with
irregularity in the uterine functions " (and we need not sub-
tract more than a fraction of these), " there will remain but
few in whom the hemoptysis did not depend upon disease in-
curable and progressive in its nature, of the lungs or of the
heart; and if we further subtract those persons in whom the
88 FHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
hemorrhage was symptomatic of cardiac disease, there will be
very few indeed left in whose lungs the existence of tubercles
may not be confidently predicted."
TREATMENT OF HEMOPTYSIS.
The management of these cases is very important; for if the
lung is left obstructed here, the seat of extravasation is likely
to become the seat of tubercular deposit and a vomica; in cases
preceding tubercularization with much arterial excitement, I
have found Aconite a very serviceable remedy, especially if
patient used wine or had been exposed to cold dry air ; Veratrum
viride for removing congestions of the lungs, especially if we
have heart complications, ranks very high. Elaps corallinus is
also an excellent remedy; Plumbum aceticum is another. Of
course the totality of symptoms must guide in this class of
cases as everywhere else. Then upon Phosphorus, Lycopodium,
Silicea and Sulphur, I have largely placed my dependence for
the removal of later dangers from hemoptysis. I will report
a case showing the results of this treatment.
Anastasius Nicholas, of Greek extraction, set. about 40, had
been subject to slight hemoptysis for several years; was small
of stature, dark complexion, somewhat flattened antero-pos-
teriorly about the thorax, and had but little energy physically.
Was taken with a hemoptysis in the fall of 1870, while in New
York ; case was very severe ; as soon as patient could be car-
ried he went to his home in Vermont, where he was again
taken almost as soon as he got home, and we were called;
found him looking pale, covered with blood, and in great ap-
prehension; gave reply to questions only by motions very
cautiously made; blood was dark; pulse not accelerated, but
rather slower than natural. Gave him Veratrum viride; no
very active bleeding followed, but he had the taste of blood in
his mouth, and a lacerated feeling about the heart; spitting up
occasionally a little blood with indications and fear on pa-
tient's part and my own that bleeding would return. Gave
Elaps corallinus in place of Veratrum; all tendencies to hemor-
rhage were controlled in the next twenty-four hours, and no
bleeding has ever followed so far as we know; but we had in-
flammation of the lung to control with Phosphorus, and later
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 89
purulent expectoration and hectic fever to subdue with Lyco-
podium. The case for weeks seemed one lingering along as
tubercular phthisis, and we actually had a cavity of consider-
able size open up in the right lung in the region of the third
rib. We had as symptoms for the use of Lycopodium, hoarse-
ness; feeble, husky voice, with irritation in the trachea; cough
more loose in the day, and tightening up at night; sputum
dirty, grayish-yellow and purulent; could not lie as well upon
the left side, upper right side affected ; flushes of heat toward
evening, and sour night sweats. Patient was apparently well
in six months, and is still living.
Aconite. — The power which Aconite is known to possess
over the arterial circulation, leads us to think of it in our
cases of active hemoptysis; and its influence upon the par va-
gum, the principal regulator upon the heart's action, as well
as modifier of the lung's movements, certainly does entitle the
remedy to a rank of the very highest order for hemoptysis,
especially when it results from over-distention and excitement
of the arterioles, or the heart's disturbance; and in these points
I think it will be admirably supported by Cactus. The blood
is of a bright red color, foamy or filled with air-bubbles usu-
ally; comes up easily from hemming or hawking, sometimes
with a gush. There is much excitement and anxiety — often ap-
prehension of death. The pulse is quick; there are stitches in
the chest and palpitation among the accompanying symptoms.
The hemoptysis is often brought on from using stimulants ;
from exposure to cold, dry air and northwest winds.
" Man, set. 35, has suffered for several years from cough, with
scanty expectoration of mucus, frequently raising blood upon
even slightly exerting himself; loss of flesh; has had for one
week profuse hemoptysis; allopathic treatment with a bleed-
Symptoms: — So weak that he can hardly speak or hold him-
self up; paroxysms of coughing with raising of blood, come on
often ; about every two hours ; he loses from one to two tea-
cups full of bright red, foamy blood, preceded by the usual
symptoms ; the face is pallid, surface of the body cool, pulse
small, frequent, hard, from 100 to 110; stitches and feeling of
90 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
tension throughout the chest; breathing short; exhaled air
hot; no appetite; much thirst; bowels normal; no sleep at
night. Gave Aconite 24 , one drop every two hours. Oct. 20th,
he feels better; the cough is better; has had no paroxysms
since yesterday; expectoration still mixed with a little dark
blood; feels stronger, freer in the chest; no more stitching
pain; pulse fuller, soft, 80; sleeps. Gave Aconite 3 , every four
hours. Oct. 21st, continued improvement; no trace of blood.
Aconite 6 , one dose each day. On the 30th well ; the chronic
cough removed by a few doses of Sulphur." — Hichelheim,
Hygea, VII, p. 136.
Arnica. — Arnica is especially adapted to hemorrhages of the
lungs following mechanical injuries. The blood may be either
black or of a bright red color; frothy blood mixed with mucus
and coagula, is a form which Arnica sometimes controls. At
times the stomach is disturbed, which seems to come from an
irritation and tickling in the right lung. There is a periodi-
cal flushing of heat which increases the action of the heart ;
raw feeling in the chest; sore feeling when coughing.
"A man, get. 62, of sanguine-bilious temperament, cured of
the itch in his twentieth year with Sulphur. At no previous
time suffering from any chest trouble, was suddenly taken with
hemoptysis. On the day before, he had taken half a bottle of
wine. S}rmptoms, during the last half hour: he has raised
bright foamy blood (Aconite) mixed with clots and mucus, ac-
companied with moderate vomiting, which seems to be caused
by an irritating tickling in the right lung, near the insertion
of the right bronchus into the trachea. He can breathe deep ;
there is a periodical increase of heat and rush of blood into
the chest, accompanied by increased action of the heart; the
pulse is small, contracted, slow. The countenance looks pale;
hands and feet are cold; occasional attacks of faintness. Pre-
scribed Arnica 4 ; repeated on the second day. Soon after tak-
ing the first dose all the symptoms disappeared, and he was
discharged cured on the third day." — Trinks in Annalen der
horn. Klinick, I, 286. Hempel and Arndt's, Mat. Med., Vol. I,
Belladonna. — The influence of Belladonna upon the blood-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 91
vessels immediately arising from the great thoracic arch,
would naturally lead one to think that it would have a deci-
ded influence upon the circulation going on in the lungs ; it
corresponds to a flushed face, excited carotids, irritation of the
larynx or tickling in the trachea, pressure upon the chest above
the epigastrium. Sometimes nausea which rises up into the
throat. Perhaps burning heat in the chest, or heat beginning
in the abdomen and rising suddenly up into the lungs and
passing as suddenly away. Sticking pains may be felt in
various parts of the chest. Sometimes there is the taste of
blood in the mouth as in Hamamelis and Elaps. Skin is hot
and considerable hyperesthesia in general.
"A girl, set. 19, blooming, hearty, solid, was taken with a
hemorrhage from the lungs after experiencing aches in the
chest and hoarseness. Symptoms: sensation of pressure in
the chest; anxiousness with simultaneous feeling of ascending
warmth, greatly increased redness of the face, burning hot
cheeks and forehead; tickling in the trachea, and expectora-
tion of clear blood to the amount of a teacupful; cold hands
and feet, small irregular, rapid pulse. Gave Belladonna 30 ;
after thirty minutes quiet sleep, very little hacking, and that
without expectoration ; relapse on the ninth day, met at once
by Belladonna, and again five days later; to remove this ten-
dency Natrum mur., Sulphur and Lycopodium were used.
When I saw her four years later she was perfectly well." —
Thorer, Arch., XIX, 3, 114.
Cactus grand. — Cactus is indicated for hemoptysis with
marked arterial excitement, though less than with Aconite, and
when the heart is implicated. A squeezing, constrictive pain
about the heart or scrobiculus is often felt; attacks of anxiety
and threatened suffocation ; also sharp, wandering pains about
the scapular region. Congestion of the chest which prevents
lying down is not uncommon. Beating of the abdominal aorta
may be felt. A sense as if an iron band prevented the normal
motions of the chest may be found present. Spasmodic
cough with copious mucus expectoration, or a cough with
thick yellow sputa like boiled starch; such are the chief indi-
cations for using Cactus; all the more strengthened if there
92 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
should be a rheumatic complication with our hemoptysis.
The palpitation of the heart so common where Cactus is indi-
cated is worse by lying on the left side. Cactus patients are
frequently spare, suffering from what is often called nervous
Cinchona officinalis. — Cinchona seems well adapted to
such persons as suffer from anaemia and passive congestions,
to hemoptysis which shows a periodical tendency of returning
every other day, or follows from loss of blood; also to patients
who use alcoholics. " Singing in the ears and faint spells," Her-
ing gives as an indication ; "rush of blood to the chest and head
with excitement of the carotids" (Belladonna) is also given as
indicating the use of Cinchona. " Craving of sour things in
connection with hemorrhage," Hering gives as an accompany-
ing symptom. Patients want the head high; are subject to
sudden prostration ; troubled with stitches under the sternum
and in left chest, which are worse during movements and deep
inspirations (Bryonia), and also from slight touch. Cinchona
has a clinical record for curing suppuration of the lungs fol-
lowing hemoptysis, also for curing the phthisis of drunkards.
"A woman, set. 40, has been nursing for six months her
tenth child. She had formerly been perfectly well ; never had
lung trouble. Has had cough with expectoration of blood for
last two weeks. Symptoms: the woman seems strong, but
always looks thin and miserable; nearly constant dry, hack-
ing cough, with some pain in the chest every morning half
an hour after rising, with constant tickling in the throat and
some oppression of the chest; expectoration of bright red blood,
about four ounces ; with it great exhaustion ; cannot stir; pulse
small, thread-like, rapid, 100; appetite poor; bowels consti-
pated for three days; mind apprehensive. Prescribed imme-
diate weaning of the child, and two doses each day of China 12 .
After the third dose the cough ceased, and she was well after
receiving twelve doses." — Hichelheim, in Hygea, VII, 142.
Digitalis. — Digitalis is often indicated in hemoptysis con-
nected with tubercular infiltration and diseases of the heart.
Distended veins, especially about the head; pale, livid face;
coldness of the skin, with cold sweat and irregular pulse, are
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 93
the usual accompaniments. Palpitation, or disturbance of the
heart's action is also very common.
It has been used successfully for pulmonary hemorrhage
preceding menstruation, when pains in the chest, back and
thighs have been associated: Heart disturbances usually ac-
company Digitalis symptoms.
Elaps corallinus. — Dr. Charge" speaks highly of Elaps co-
rallinus in hemoptysis, and we have found it a very excellent
remedy ourselves. The indications are expectoration of dark
venous blood, almost black, though we have seen its beneficial
effects in cases where the blood was not so dark ; there is the
taste of blood in the mouth (Hamamelis) and a feeling of lacera-
tion in the region of the heart. It would seem to be best
adapted to the venous variety of hemoptysis as is Hamamelis
and Veratrum viride. It seems to impress the heart with its
influence somewhat as does Cactus, though Cactus has the
squeezing sensation rather than the lacerated.
Ferrum. — Has hemoptysis with bright colored blood (Aconite,
Cactus, Ledum) and inter-scapular pains with slight cough.
Patient has to sit up, and feels better when walking slowly
about, though he feels too weak to keep erect. Is indicated
when hemorrhage of the lungs follows arrest of the menses, or
is connected with the debility that follows onanism ; also when
following from removal of supporting walls to vessels where
cavities exist, when the color is bright red.
Hering mentions the symptoms, " feeling of soreness below
the clavicle and under the left nipple."
Paue says: "Quick motion and talking bring on cough;
there is pain between the shoulders; face has a yellowish tint;
sleep is poor at night, and there is frequent palpitation of the
Hamamelis. — Hamamelis has proved to have blood-staying
action, upon the vessels of the lungs as well as those of the
uterus and intestines, has arrested cases of hemoptysis occur-
ring in connection with a tickling cough and where there was
the taste of blood or Sulphur in the mouth. Tightness of the
chest and a difficulty in keeping the recumbent posture (Fer-
rum, Cinchona) have been accompan} T ing symptoms. Some-
94 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
times frontal headache with a sense of constriction in the chest,
the sense of constriction being increased by taking a long
breath. Dr. W. E. Payne cured a case where the blood came
into the mouth without any effort ; a teaspoonful or so every two
minutes ; it seemed to issue in a warm current from below the
right clavicle as patient represented the sensation ; there was
also the sensation of a hard body in that region ; blood was of
a venous character.
Ipecacuanha. — The hemastatic properties of Ipecacuanha
have been known for a long time. It would seem to correspond
to both the inflammatory and spasmodic element. The hemor-
rhage to which it seems to be best adapted is that which is
aggravated by the least motion (Bryonia). The blood is of a
light red color (Aconite, Ferrum, Ledum), nausea frequently
being an associated symptom. Sometimes one hand is cold
and the other hot. Morning expectorations of light red blood
and mucus are among the clinical verifications, and often
vomiting or retching has been associated.
Kreosotum. — Its action seems to be upon the vegetative
system of nerves and the venous vessels of the circulatory sys-
tem, corresponding to a low grade of vitality, with a tendency
of the secretions to rapid chemical degradation. Corrosive- ,
ness and fetor are likely to be characteristic of all glandular
exudations to which Kreosote is applicable, and burning heat,
a sensation apt to be felt at seat of disease. Complexion livid,
possibly oedema of the feet and puffmess about the face; irrita-
ble in disposition. The cough is whistling and dry, occurring
more often in bed in the evening, accompanied with a crawling
feeling below the larynx or in the upper bronchii. The hemop-
tysis has usually been periodical, with pus-like sputa where
our clinical records are of most value. For expectoration of
black coagula it has also proved a remedy. Another form is
blood-spitting, with severe pains in chest; with afternoon fever
and morning sweat. It may be thought of in hemorrhages con-
nected with abscesses secreting a foul purulent matter, where
there is burning at the seat of the vomicae, or a craivling feeling
in the upper respiratory tract.
"A tailor suffered from periodical hemoptysis; was fever-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 95
ish; could only lie on one side; had aches in the chest; yel-
lowish-green purulent expectoration, and in fact every evi-
dence of phthisis. For four successive days he received one
dose per diem of Kreosotum, four drops on sugar. The bleed-
ing ceased after the first dose and patient got well." — Arch.,
XVI, 2, 169.
Ledum. — Many cases of hemoptysis which have called for
Ledum, have occurred from troubles of the heart, as in Cactus,
which it supports very well. Hemoptysis, alternating with
rheumatism, finds a remedy not infrequently in Ledum. Con-
gestion of the lungs, stitches in the chest, and soreness under
the sternum are frequent accompaniments. Palpitation and
pressure at left edge of the sternum is another sympton. Hem-
orrhage at midnight and in the morning, occurring in connec-
tion with a purulent fetid sputum has been found amenable to
Ledum, the blood being bright red and foamy. A beating head-
ache often accompanies or precedes hemoptysis. Hemoptysis
is a pathogenetic symptom of Ledum, and Noack and Trink
say it has a powerful action upon the lungs. Eruptions and
tubercles on the face, and herpes on the body, which have been
occasioned by its use, would indicate a very decided action
upon the mucous membranes certainly. Then, we have small,
red, constantly itching pimples on the chest with biting itching,
from the provings.
Ledum patients have hot hands and feet, as in Sulphur, par-
ticularly in the evening ; they cannot bear the warmth of the
bed for the heat of the limbs. Heat of the body has been
found troublesome in patients afflicted with hemoptysis.
Another symptom is, long-continued warm sweat on the hands
" A young cachectic woman had cough with expectoration
of blood. Symptoms: the attack which had formerly occurred
on various occasions and had usually been cured under allo-
pathic management in six to twelve weeks, came on from a
violent excitement during catamenia. Very oppressed; rapid
breathing; chest feeling as if pressed together; worse from
motion or speaking; hard, hollow cough, jarring the chest and
head, with expectoration of large amounts of clear, bright red
96 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
blood, so that she had lost more than a pint. Terrible beating
headache; bloated face, now congested, then pallid. Loud
noises before the ears, with hardness of hearing; tickling in the
trachea ; painful soreness below the sternum; feeling of fulness
in the upper abdomen ; constipation ; oedema of legs and feet ;
annoying drawing pains in the extremities whilst lying quiet ;
feeling of heat all through the body, alternating with moder-
ate perspiration; quick, full pulse; general lassitude. Gave
Aconite, one dose. After nine hours Ledum pal. Bleeding
ceased on the following day, and in three more days the pa-
tient was performing her usual duties." — Veidel in Arch. XII,
" A young man was attacked with stitching pain in the right
hip; later, the knee joints and joints of the feet began to swell ;
some months subsequently and when the rheumatism had
subsided, he was attacked with a fit of coughing followed by
hemoptysis. The cough continued for weeks with an expecto-
ration of thick, greenish, foul and fetid sputum. At this time
there were evidences of a cavity in the left sub-clavicular re-
gion. Various remedies were tried, and the hemoptysis oc-
curred the second time. Patient sank rapidly with signs of a
galloping phthisis. Four globules of Ledum 30 , given dry on
the tongue. Prompt improvement followed, which was further
forwarded by giving Ledum 200 ." — Dr. Stens, Sr. by Dr. Hoyne,
in American Homceopath.
Lycopodium. — Lycopodium like Sulphur seems to have a
marked capabilit}^ for removing capillary congestion and a
condition of overdistention in the arterioles. The cases in
which we have had experience were marked with a very de-
cided febrile action and with an afternoon aggravation. The
fever has usually had the accompaniment of flushing heat ;
sometimes there has been the sense of continuous pressure
upon the chest very much like that of Phosphorus, which it
further resembles in that patients are worse by lying on the
"Patient, set. 40, has been exposed to night air for years;
suddenly roused from an afternoon nap by copious spitting of
blood; checked by astringents after the loss of a half pint of
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 97
blood. On July 20th, called and found him feverish, restless
and weak. Gave Aconite 2 every two hours ; was called again
in the evening, he having raised about a pint of blood ; the
fever was much more severe and patient quite weak. Millefo-
lium soon arrested the hemorrhage. Aconite and Millefolium
then in alternation; later China 3 every two hours. July 21st,
on examination the upper portion of both lungs disclosed a
dullness on percussion with bronchial respiration and mucous
rales; dullness mostly on left side, but more soreness on right
side; constant hacking cough with bloody sputa. Ipecacuanha
every two hours; frequent change of remedies with alarming
symptoms steadily increasing. During September gave Arnica,
Arsenicum, Kali c. and Lycopodium without relief. Oct. 1st,
Calc. phos. by advice of counsel ; prognosis very unfavorable ;
appetite poor, greatly emaciated; bright, glassy eyes; red spots
on cheeks; severe hacking cough; profuse night sweats-
worse at 4 p.m. Lycopodium given again with rapid improve-
ment, which was continuous." — A. M. Cushing.
Phosphorus. — Dr. Holcombe gives us from his provings of
Phosphorus, " sensation of heat in the lungs ; disposition to take
deep inspirations with discomfort in doing so; shooting pains in
the right side of the chest; severe pain in the posterior part of
the left lung, aggravated sometimes by inspiration and some-
times not; tickling cough, fugitive thoracic pains." If the long
narrow stool be present, it is an important characteristic.
Wanting cold food, particularly milk, is characteristic. It has a
fine clinical record for controlling hemoptysis coming on from
tubercularization of the lungs; is best adapted to tall, slender
and rapidly growing persons; the florid complexion and
attenuated muscular development give the best type for
Phosphorus. In cases of bleeding from an enfeebled circula-
tion, as in fatty degeneration of the heart, Phosphorus again be-
comes indicated. A valuable symptom is pressure upon the
chest when coughing, or sticking pains at the epigastrium, creat-
ing a desire to press the hand there for relief. The color of the
blood is red as in Aconite, Cactus, Ferrum, and Ledum. The
febrile symptoms are marked, and the nervous system much
98 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Ebullitions and congestions are marked in the provings of
Phosphorus. Raue recommends it for profuse hemorrhages
pouring out freely and thin, ceasing for a time. We have
often given it for blood-spitting in phthisical patients of the
florid complexion and of an excitable temperament, with satis-
factory results. In one case we remember patient preferred
cold food, and had a relish for cold milk in particular. Sudden
general weakness is very characteristic of Phosphorus. The
rough, raw, scraped sensation in the throat conjoined with
similar sensations in the trachea and chest are emphasized by
Dunham, as well as the stitches in the left side of the throat, going
toward the ear and up to vertex. Hering gives, " cannot talk
without pain in larynx." Lippe, "trembling of the whole
body in coughing.'' Raue gives, "profuse hemorrhages, pour-
ing out freely, then ceasing for some time."
Phosphoric acid. — This remedy has much analogy to
Phosphorus which we have just been considering; the same
nervous irritability and congestions in the chest as indicated
by the violent pain and oppression ; the tickling sensation ex-
tending down to the epigastrium has other correspondence.
Stomach symptoms are very common even to dyspepsia.
Hering gives, "spasmodic tickling cough with expectoration
of dark blood in the morning," but we incline to think the
hemoptysis will usually be florid as in Phosphorus. It also
has much correspondence to Cinchona and quite a little to Fer-
rum, both of which have the symptom of florid blood. There
is also a iveak feeling in the chest as in Stannum. The restlessness
resembles Rhus tox. Weakness, restlessness, heat, but not averse to
being covered as in Secale, tendency to faint after meals, from
loss of blood and from emotions, added to the constitutional
symptoms, will usually be a safe guide. The hemoptysis of
onanists very frequently calls for Phosphoric acid.
" H., set. 20, has for years been troubled with cough followed
by spitting of blood, with violent pains in lungs and dyspepsia ;
no improvement after three months of allopathic treatment.
Symptoms : a large amount of bright red foamy blood is ex-
pectorated after previous hawking, accompanied with a sensation
of fulness, great internal restlessness so that he does not know what
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 99
to do with himself and with tickling cough; there are also
stitches in the chest, especially when taking breath, drawing
pains in the small of the back, loss of appetite, constipation
and great pallor of face. Aconite 2 and later Arnica 6 produced
merely a temporary improvement; the bleeding ceased en-
tirely after Phosphoric acid 3 ." — Heffendahl in Allg. Horn.
Zeitg., IX, 24 J.
Plumbum aceticum. — We have hemoptysis mentioned by
Sund, and suppuration of the lungs by Richt, from Plumbum
ac. Hering mentions a cough with expectoration of blood or
pus after hemorrhage from the lungs; cough worse lying on
the bach and after getting out of bed in the morning ; also re-
commends it for a dry, hacking cough in tubercular constitu-
tions, with pressive pains in the sciatic nerve. Constipation
or diarrhoea are frequently present, more often constipation,
with great inertia of the bowels. The sheep-dung stool is quite
characteristic of Plumbum. The febrile symptoms are internal
chill with external heat; heat with thirst, anxiety, redness of the
face and sleepiness.
Schlecher (Allg. Horn. Zeitg.) relates the case of a woman
who presented all the physical signs of advanced consumption
with the following symptoms: "Great emaciation, fever with
nightly exacerbations, prostration, diarrhoea, good appetite, ca-
chectic appearance, hectic flush, constant cough day and night,
copious exjDectoration of chunks of greenish pus streaked with
blood, sharp pains in the side. Bryonia only relieved the pain
in the side; four doses daily of Plumbum ac. restored the
patient to a fair degree of comfort." — Hempel and Arndfs Ma-
"A man, set. 70, of a slender make, was attacked with a
violent cough, discharge of a quantity of bright red, frothy
blood, coldness of the extremities, chilliness followed by heat;
irritated, hard, accelerated pulse, constipation, thirst; palpita-
tion of the heart, undulating feeling of malaise and warmth in
the chest, embarrassed feeling about the head. The patient
was promptly cured with a few doses of the acetate of lead." —
Hempel and Arndt's Materia Medica.
Rhus toxicodendron. — Like Arnica, Rhus tox. seems to
100 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
have a power to restore the tone of tissues strained or over-
worked. The cases of hemoptysis where it has proved most
serviceable, are those which have followed strains, and over-
exertion of the chest organs from blowing upon wind instru-
ments. The blood is florid in color and is apt to be renewed
from the least mental excitement. — Usually a pain in the lower
chest is felt in connection with the hemoptysis ; there is a va-
riety of hemoptysis associated with a tearing cough and purulent
expectoration where clotted brown blood has come up from the
bronchii; the cough is worse from evening to midnight, be-
ginning perhaps at about 7 o'clock, the periodical febrile period
of Rhus toxicodendron. Soreness and stiffness of the muscles,
especially of the nape ; restlessness, relish for cold milk as in
Phosphorus, are frequent accompaniments. Burt gives, " bloody
sputa raised with great difficulty, with high fever." "Worse at
night, particularly after midnight," Guernsey. Dunham em-
phasizes, " constriction of the chest; short, anxious respiration;
stitching pains in the sides and the hypostatic congestion."
Sanguinaria Canadensis. — This remedy resembles more
closely than almost any other the active inflammatory symp-
toms attending tuberculosis of the lungs; and it has been used
with success in arresting hemoptysis occurring from tuber-
cular irritation. Flushes of heat, soreness and burning in the
lungs, stitclies in the chest going to right shoulder blade, nausea or
tickling at the stomach which causes coughing, flying heat from the
head io the stomach, quick, small pulse and palpitation of the
heart are guiding symptoms. Passages of flatus connected with
the cough or disturbance of the stomach would support the other
symptoms and strengthen our reasons for selecting Sangui-
naria. Circumscribed redness of the cheeks in the afternoon }
fever from 2 to 3 P. M. daily, is very suggestive of the blood-
root. It is more often called for when hemoptysis sets in dur-
ing the progress of phthisis pulmonalis.
Secale cornutum. — Guernsey recommends Secale for pas-
sive hemorrhages in scrawny cachectic subjects; in conditions
where the corpuscles have a tendency to break down lacking
fibrin; especially, for weakness attending, which does not
come on from previous loss of fluids. (Opposite of Cinchona.)
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 101
The hemorrhage to which Ergot corresponds, gets worse from
motion (Ipecacuanha, Bryonia), its special action is upon the
uterus, but it has proved of service in both hematamesis and
hemoptysis. It has a very decided action upon the spinal
system of nerves, in consequence of which we often get loss of
muscular action ; exhaustion may be accompanied with sink-
ing spells more often at about 3 o'clock a.m. Patients dislike to be
covered even when the skin feels very cold ; pulse, thread-like and
Sepia. — Mrs. W., set. 50, of a sanguine-nervous temperament,
tall and spare, of scrofulous habit. A son and daughter have
died of pulmonary consumption, and scrofula shows in her
grandchildren. Taken with hemoptysis. Local physician re-
fused to take charge of the case for the reason that he con-
sidered it a case of consumption. We found her much pros-
trated with pain in the forehead, dyspnoea, slow pulse and cold
extremities. Learned that extremities had been inclined to be
cold for weeks; urine very offensive; thick and dark; a sedi-
ment in commode of a clay-colored substance. From the
slowness of the pulse and imperfect circulation we were in-
clined to think there was a rheumatic complication, although
there was no pain except in the head. Gave Sulphur 30 , fol-
lowed by Benzoic acid ; soreness and slight swelling of ankle
joints in the course of three days, with relief of head and
chest symptoms. Urine still of the same character; much
prostrated by fever and a want of natural warmth of the*body ;
so weak she has to be lifted from the bed; a hacking cough,
which is worse from lying on the left side (Phosphorus);
brownish spots about the bridge of the nose; forehead and face
look as if inclined to freckle. Sepia 200 cured the case, so that
she remained well for a few years, though we think she died
later with consumption.
Stannum. — Stannum has been given for hemoptysis where
there was copious expectoration and the feeling of excessive
weakness in the chest, so characteristic of the drug. There has
been an oppressed feeling aggravated when lying down in the
evening and also from motion. Soreness and stitches in the
chest are noticeable symptoms. The fever is more marked
102 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
from 4 to 5 p.m., as in Lycopodium ; that is, in the hands (Le-
dum, Sanguinaria, Sulphur), especially in the evening; and
then we have anxious heat as if perspiration was about to oc-
cur. The feeling of weakness is often felt also at the pit of the
stomach; all gone feeling it is called. The symptoms of Stan-
num frequently increase and decrease in a sort of crescendo di-
A few additional remedies we have found to be of service
in hemoptysis, among which are Carbo veg., Veratrum vir.
and Sulphur. The well-known hem astatic powers of Carbo
veg. in epistaxis have led me to try it also in hemorrhage
from the lungs, and we fancy with very good results. In one
case where it was tried there was a sense of constriction accom-
panied with burning. (Sanguinaria.)
We have given Sulphur more frequently as a support to
Cactus, Phosphorus or some other remedy, than alone; and
yet it is not lacking in power to control capillary congestions
and excitements, out of which a hemoptysis often arises. It
proves curative to an expectoration of dark blood with stitches
in the chest, particularly extending to left scapular. (Right,
Sanguinaria.) There is a feeling of weakness in the chest, but
not so pronounced as in Stannum. Heat in the vertex and hot
palms and soles are other indications. In conclusion, let me
add, that there are many other remedies which will be found
to be adapted to our cases of hemoptysis. The similimum of
the whole case is the remedy of all others to take precedence.
Veratrum vir. has been used by us somewhat empirically in
cases of hemoptysis, but is of too much suggestive value to be
here omitted. No remedy has a more profound action upon
those nerves which supply the capillary vessels of the lungs, if
we may judge from the intense congestion it is able to pro-
duce. Acting upon this fact, we have given the remedy, and
to our satisfaction. The burning pain in the region of the
heart, faint feeling at the stomach, accompanied with nausea
and the slow intermitting pulse, may be taken as good indica-
tions when they exist. The space we have taken to present
the leading remedies for hemoptysis, will need no apology
when we remember how many cases of phthisis pulmonalis
come to us beginning with a hemorrhage from the lungs.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 103
The importance attached to bronchial inflammations by Ger-
man and French physicians, gives special prominence to ca-
tarrhal affections as bearing upon phthisis pulmonalis. If
mucous casts block the alveoli, or more exactly, catarrhal mu-
cous cells and fibro-plastic nuclei mix together and fill the
alveoli, giving us the condensation which so often ends fatally
in the form of a phthisis, how very carefully should we watch
our catarrhal affections. There can be no doubt about hyper-
trophy of the mucous membranes following a protracted in-
flammation. That pressure upon the vessels in consequence
of the hyperplasia, may to a large extent cut off nutrition; that
even the inflammation may extend to the fibrous structure
thickening the parent tissue, is not difficult to see. Lastly,
that from such a beginning all the graver evils attending cas-
eous degeneration and tubercle may follow.
We accept, then, the statement of that class of pathologists
who believe that quite a per cent, of our chronic catarrhs
finally terminate in caseous exudation and end in destructive
wastes of the tubercular passages and the lung tissue proper,
as a final result. Some die of chronic laryngitis before pro-
gressive disintegration reaches lung tissue; others of bronchial
ulcerations and dilatations, which become pus receptacles.
The disease is comparatively slow, and, as a rule, not pri-
marily of the tubercular diathesis, and is much more amena-
ble to remedies; indeed, should almost without exception be
arrested short of a fatal termination, if attended to in season.
The greater the tendency to tubercle, however, the greater
our difficulties. For the mucous membrane as well as the
parenchymatous structure of the lungs is liable to tubercular
exudation, though perhaps not as liable. In the progress of a
catarrhal consumption, we have ulcers disintegrating portions
of the larynx; trachea, bronchi, and, as a rule, the lungs will
become implicated, revealing caseous products and cavities as
a later accompaniment; the last appearing after the vital
104 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
forces are pretty nearly undermined. The pressure that fol-
lows from the hypertrophied mucous membranes prevents free
ingress of air to the air-cells in the apices, and they load down
with the cheesy deposit, carrying disease also to the parent tis-
sue. Catarrh may be found wherever the mucous membrane
is found, and we may find it changing its seat of action from
one locality to another, just as we see rheumatism and many
of the skin diseases shifting from one locality to another;
always, however, adhering to the same kind of structure.
Skin diseases, especially, tend to migrate to the mucous
membranes, and are often the real cause of a catarrh itself.
And then, again, the appearance of certain skin diseases are
an indication that a diathesis exists, which may become the
soil out of which tubercle sprouts. Such condition warns of
danger and demands proper remedial measures.
A catarrh of the stomach may be the leading step to defec-
tive nutrition and imperfect assimilation, favoring the later
step of arrest in vitalization and lead to tubercular exudation.
The study of these points will lead to better treatment of our
Properly indicated remedies such as Argentum, Calcarea
carb., Calcarea phosph., Carb. veg., Natrum sul., or mur., Lyco-
podium, Nux vom., and Sulphur, should be early administered.
Catarrhal affections of the vaginal passages and uterine cavity,
again, are the sources from which are transplanted nasal and
tracheo-bronchial catarrhs, which later may end in caseous
exudation in the apices. We have seen two such cases die in
a colleague's hands within a year. By no means should these
Again, too severe condemnation cannot be made of the prac-
tice of using such local measures as tend to suppress the local
expression when upon the utero-vaginal membranes, sending
it to more vital localites in the organic scale.
Alumina, Calcarea carb., Kali carb., Kreosotum, Lachesis,
Lycopodium, Pulsatilla, Sepia, Sulphur and Thuja, are agents
at hand, together with others, which if carefully selected will
eradicate all danger from this source. Some of these remedies
we have noticed in considerable detail in previous pages of
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 105
Returning to the respiratory organs, we may begin with a
nasal catarrh, where we find more frequently the anterior
nares, and the irregular cavities called the nasal fossse, into
which they lead, the starting point.
The mucous membrane is here most exposed ; perhaps the
posterior nares at this step become involved. Traveling
downward we have pharyngeal complications, and from the
naso-pharyngeal we have chronic laryngitis, and then tra-
cheo-bronchial affections, all growing out of the primary seat
of the disease by continuity of similar structure. We do
not say that this is always the case, for a catarrh coming on
from retrocession of any skin disease, or from a metastasis
from the uterus or alimentary canal, may seize upon any of
these points, and there develop the force of its morbific action.
Right here let it be remarked that the nasal douche is often
responsible for a catarrh of the bronchi, because the remedies
only suppress and do not cure. As so many cases of consump-
tion have a beginning in catarrhs, or are allied with catarrhs,
we feel justified in giving in this place a comprehensive digest
of treatment, with clinical cases to verify. A complete treatise
upon consumption should in our judgment include to some
extent the treatment of catarrh and pneumonitis, as well as
hemoptysis. The law of metastasis is well illustrated as well as
a clinical indication made by the following case from Knorre.
" A girl, aet. 18, was afflicted every winter with a moist erup-
tion upon both hips; when it disappeared she had catarrhal
inflammation of the septum and alas on the inside ; discharge
of a thinish mucus which was acrid, excoriating the upper
lip and obstructing the nostrils. Scabs were apt to be yellow-
ish-hued. There was a burning sensation aggravated by sneez-
ing or blowing the nose and by touching it; was worse also in
the morning. Patient had a pale, sallow countenance; was
cured by Magnesia mur.V
To this I will add a case of my own cured by Acidum nitr.
A Mr. Kendall was troubled with an eruption about the anus
which seemed to belong to the family of eczema. It annoyed
him exceedingly from itching; there was an exfoliation of
thin scales and a moist serous exudation. When the humor
106 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
disappeared a hoarse bronchial attack came on attended by a
violent cough, mostly dry, accompanied with sharp, sticking
pains in the throat-pit. At times hoarseness amounted almost
to aphonia. Acidum nitr. 3 cured the whole difficulty in a
little while, the eczema not returning. I remember a fine
record in treating a case of the catarrhal variety of phthisis
with caseous exudation into the apices made with Causticum 200 .
Patient was an elderly lady approaching 60 years. Counte-
nance was a pale earthy, or dull chalky color. Had been trou-
bled a long time with a cough and general catarrhal symptoms ;
voice was nasal and husky; flesh was soft and flabby; easily
put out of breath from exercise, and but little muscular en-
durance. Patient was attacked with a severe cold which so
prostrated her that she went to bed with considerable fever,
followed by an intense aggravation of all the tracheal and
thoracic symptoms; muco-purulent expectoration followed, of
a very heavy character and only a shade more yellow than
cream, appearing to the eye somewhat as cream does, only a
little more dense; indeed, it was very firm and compact. The
sputum was very abundant and came up in detached masses
after severe coughing spells. Throat and chest were sore
when coughing. Patient was sad and of complaining mood,
almost beside herself; said she would drown herself, for she
would not spit herself to death; very much out of humor;
easily vexed and irritable. She recovered from her acute at-
tack in two weeks with Causticum, and even advanced far be-
yond her previous condition.
I am fully assured that this case had a complication of
tubercle or caseous exudation. Patient died three or four
years later with consumption in the hands of another. It is
now my opinion that Causticum could have been made to do
much more for the case by using the higher attenuations at
long intervals. As it was, I got my patient off my hands in a
fairly creditable manner, and when three years later she came
to want a physician, she went to another party to show her
gratitude, and easily got her passport without being obliged to
take herself off at her own hands.
Catarrhal consumption may be divided into three stages:
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 107
First, catarrhal, with thickening of the mucous membrane
and pressure upon air-cells and subjacent tissue; second, with
caseous exudation as a complication, and third, with softening
and disintegration of caseous matter carrying down surround-
ing tissue. These different stages should be carefully studied
and promptly met with appropriate treatment. The first is
easily cured, the last is very difficult.
THERAPEUTICAL INDICATIONS AND CLINICAL
Alumina. — Well adapted to catarrhs engrafted upon an
anaemic state of the system and with constipation associated.
Such persons often have perverted tastes, wanting charcoal,
chalk, cloves, or other indigestible things. Perhaps they have
been afflicted with tetter or other variety of skin disease. The
catarrh often begins in the ears where there is to be found ul-
ceration of the mucous membranes. Scurfs are perhaps found
in the nose, the septum is swollen, the root of the nose tender;
redness about the nose is a frequent accompaniment. As the
catarrh progresses downward we have huskiness of the voice,
mucus accumulates in the throat, dropping down from the
posterior nares, or a tough secretion is thrown out from the
laryngeal follicles difficult to be raised because of its adherence.
The cough is aggravated by talking or singing, by eating such
things as pepper, salt and vinegar, and by cold air; cough
worse in the morning. Catarrh apt to be worse on alternate
days. Alumina patients take cold on the slightest exposure
(Hep. Calc), though they feel better in the open air. They
cough a long time before they are able to raise; sometimes a
sensation as if a loose piece of skin were in the trachea.
Clinical. — " Miss L. P., set. 17, dark complexion, excitable
temperament and of a phthisical family, had cough for three
weeks, particularly violent in the morning, raises a little after
coughing a long time, has also a cough in the evening.
Alumina lm , two doses cured." — C. Wesselhceft.
"A lady, set. 33, had for fourteen years a peculiar cough
from an irritation in the throat as of a loose piece of skin; diffi-
cult expectoration of putrid-tasting mucus; shooting pains in
108 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
the spleen. Symptoms aggravated by cold air out of doors, and
from getting tired by talking ; she is better in warm air ; pep-
per, wine, salt and vinegar set her to coughing; cannot lie on
the right side on account of her cough; riding gives her pain
in the chest.
Alumina 200 cured her after trying other remedies to no pur-
pose." — BCENNINGHAUSEN.
Mr. S. W., set. 37, of a spare habit, dark complexion, active,
amiable, has to exert his voice every day in teaching music ;
has had a constant cough now more than three years ; two
attacks of lung fever in the time ; talking and singing makes
him cough, but has a more decided aggravation at about 6
o'clock in the morning. Coughs severely for a long time when a
little sputum is thrown off; coughs some at night ; is short of
breath when walking; is hoarse and feels a tension about the
upper part of the chest.
Cured by Alumina 200 .
Ammonium muriaticum. — Is applicable where one has to
clear the throat frequently, expectorating a little dense mucus
which leaves a roughness and sore feeling behind the uvula, to
a violent cough in the evening, causing the mouth to fill with
water. Hemoptysis accompanied with itching in the larynx.
Pressure and stitches in chest as if a morsel of food had lodged
behind the sternum. Burnings are felt in small spots in the chest.
Cough is dry and tickling, annoying both night and day.
Antimonium crudum. — Epigastric and abdominal symp-
toms are usually associated with the pulmonary in Antimo-
nium crudum. Cough is accompanied with gagging or seems
to come from the abdomen. Diarrhoea is a frequent accompani-
ment. The voice is rough, feeble, talks or sings in a low and
weak tone. Perhaps loses the voice on becoming heated; coughs
worse on looking at the fire and in the hot sun, on coming into a
warm room from the cold air. Cough is convulsive, the first turn
being the most violent; raises a viscid thin phlegm deep out
of the chest in the morning; cough shakes the whole body, with
involuntary micturition. A symptom of importance if present
is violent itching of the chest with pimply eruptions, or fine red
dots as if a rash were appearing.
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 109
E. J. B., set. 35, works as a stone-cutter; of a lymphatic
temperament; has been coughing for several months; has be-
come badly emaciated because of a protracted diarrhoea of a
watery undigested character associated with his cough ; often
gags and vomits when he coughs; stomach weak and tender to
pressure and a great deal of pyrosis; tongue coated white;
coughs by fits, the first turn being the most violent; is low-spirited
and almost despairs of being cured of his pulmonary troubles.
Gave Antimonium crudum 6 ; soon was much improved and
made a good recovery; died a few years later of hydrothorax,
the result of some trouble of the heart. At the time of our
treatment of the lung and stomach troubles, patient had every
appearance of dying in a short time with phthisis ; he was of
a decidedly scrofulous habit. — G. N. B.
Arsenicum iodatum. — Is adapted to catarrhs developing
in malarial localities and in scrofulous constitutions, where
we have enlarged glands and tonsils, puffy lids, a pale face —
the hydrogenoid type of constitution as Grauvogl terms it;
where there is weak stomach and defective assimilation, often-
times the leading step to tubercular deposit. There are apt
to be burning sensations in the nostrils and throat; patients feel
the cold and are inclined to chilliness same as in Arsenicum
cases. From its power to clear the glands from accumulations
of hydro-carbonaceous matter and arrest hyperplasia, it would
seem to be a good remedy for such forms of catarrh as often
end in condensation of the apices ; possibly may be depended
upon to remove the caseous exudation itself. It is a remedy
not as yet well tested, but deserves our study and a trial where
indications seem to warrant. .
"H. B., boy, set. 16, dark hair and complexion, fleshy, but
small for his age, had suffered with catarrh for four years;
eyelids puffy; had always lived in malarial region and suffered
with chills every year; nasal catarrh attended with a jelly-like
discharge, though sometimes with a copious watery discharge,
more often in the morning or after meals; the fauces were in a
state of subacute inflammation and the tonsils enlarged.
Iodide of arsenic in the 3d trit. cured the case." — Morse.
There is much agreement in this remedy to Kali hydrojodi-
cum with which it may be compared.
110 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Bromium. — Bromium seems to act ver}*- decidedly upon the
respiratory passages, and especially upon the larynx. It
seems also to be well adapted to affections which begin in the
bronchi and travel up to the larynx, the focal centre of the action
of Bromium. Sharp pains in the thorax in cases of phthisis
which have an ascending direction suggest Bromium. Its action
upon the right lung is more pronounced, and it has been found
a valuable remedy in hepatization of the lower lobes, the right
more especially. Some pains about the clavicle lead us to sus-
pect that it will be found a good remedy in catarrh with threat-
ening of cheesy exudation into the apices, more especially of
the left lung. Such pains as tearing in left clavicle; pressure
below the left clavicle; cannot lie upon the left side (Phos.,
Lycop.); paralytic drawing pain through left chest toward the
scapula and into left arm; sensation of weakness and exhaus-
tion in the chest. The more marked action of Bromium upon
the right lung in general, and the apices of the left in particu-
lar, would indicate that the remedy acted obliquely through
the thorax and upward to the larynx. Respirations are short
and cough paroxysmal; also cough is long-continued; sounds
loose, but little or no expectoration; cough is aggravated by
exercise and on entering a warm room; voice husky, hoarse,
may have aphonia ; deep, forcible respirations become neces-
sary at times; cough excited by deep inspiration; scraping
and rawness in larfnx, and by tickling in larynx; larynx
painful to touch.
" A robust, blooming young man, set. 20, took a violent cold.
For six weeks was not able to speak loud ; absolute aphonia
in the morning, but can talk in a whisper after expectorating
under long-continued coughing (Alum.) a little phlegm. There
is present a frequent and exhausting cough, with expectora-
tion of white, whitish-yellow or yellow matter slightly soluble
in water; during the last few days expectoration of clear, dark,
coagulated blood ; constant feeling of soreness in the region
of the hyoid bone. Cough is aggravated by inhaling dust or
cold air. Cured in a short time by Bromium 3 , three times per
Calcarea carbonica. — Ranks very high among our reme-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. Ill
dies for curing chronic catarrh, especially catarrhs engrafted
upon the scrofulous type of constitution with tubercular ten-
dencies. Faults of second assimilation belong to this class of
patients to which Calcarea c. has long proved so effective. Such
persons are very susceptible to external influences, such as
currents of air, cold (Alumina), heat, noise and excitement. The
least cold seems to go through and through, one is so sensitive.
The flesh is soft, the body inclined to fleshiness; the glands to
enlargement. Patients perspire easily, especially on the head
(Sil.), and on the feet, which are often so damp as to wet the
stockings. May sweat on the limbs from the least exercise an<i
on first going to bed. Patients complain of dryness of the
throat and of a tough secretion hard to be detached, not abundant
or stringy as in Kali bichromicum. Feels as if feather doivn
was in the throat, which provokes a cough. Cough often shakes
the head and may provoke vomiting because of .the adhesive-
ness of the mucus; cough usually dry at first, especially at
night, terminating with a profuse saltish expectoration or pos-
sibly a sputum with a sweetish taste. Chronic and painful
hoarseness is often associated with the catarrh to which Calca-
rea c. is so well adapted. Patients are easily out of breath,
especially on going up-stairs; dislike the morning air and
shudder as twilight approaches; milk disagrees, while there is a
craving for eggs, as in Pulsatilla. Sometimes there is a swell-
ing over the pit of the stomach, size of a saucer; feet feel as if
one had on damp stockings; are slow to become warm in bed.
Patients inclined to dizziness in the head and wakefulness
after 3 o'clock a.m. In the chest we have uneasiness and ach-
ing pains, sometimes stitches, but they are not worse from breath-
ing, as with Bryonia. There is also an oppression which is
relieved by throwing the shoulders back. A very important symp-
tom is soreness of the chest, and particularly under the clavicles,
felt both at respiration and from pressure given by the hand. This
tenderness to the touch gives a suspiciousness of cheesy exu-
dation when found associated with catarrh, and this symptom
of Calcarea c. gives us a leading indication for its use. If we
have too early and copious menstruation associated with our
catarrh, or catarrh with condensation of the apices, with any
112 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
corroborating symptoms, it would be a strong hint for its use.
Then, again, if we should have the diarrhoea so characteristic
of Calcarea c, thin, white, undigested in character, sour of smell,
aggravated by milk and attended with a faint feeling, and fol-
lowed by great lassitude, we would have our picture complete;
but we will rarely get more than a part of our Calcarea symp-
toms in any one case; nor need we, to be sure of benefiting
"Mrs. T., set. about 53, a widow, of the sanguine nervous
temperament, has had sixteen children, nine dead; has had a
bronchial disease of five year's standing; began with catarrh
in the head which traveled down; severe anorexia; lives
mostly on milk and takes barely enough to support life; is too
feeble to be up; has rheumatic complication added to her
bronchial consumption, which increases her wretchedness. She
is chilly on the back if she attempts to rise; throat is sore in
the evening with subsequent fever without thirst; suffers with
most intense heat and shortness of breath ; heat comes with dis-
tressing flushes; is sleepless; coughs severely. Calcarea c. 200
cured." — J. H. P. Frost.
"A laborer, set. 38, intemperate, many years afflicted with a
cough, expectorating mucus and pus ; perspires freely during
the night; countenance haggard and worn; chest covered with
pustules for which Sulphur was given producing much aggra-
vation of cough and expectoration, while eruption also came
out over the body generally. Prescribed Calc. c. with immedi-
ate abatement of pulmonary symptoms, and patient went to
work a year later cured of both cough and the eruption." —
Dr. H. N. Guernsey says in cases where "abscesses form in
the lungs of young persons who are threatened with consump-
tion," he gives Calcarea carb. lm after the pus is discharged and
a complete cure is the result; the expectoration has often a
"A man, ret. 46, slender, cachectic, when a child troubled
with tinea capitis, guilty of sexual excesses; after taking cold
six months since, dry cough, physical signs pointing to tuber-
culosis; prominent symptoms are vertigo when going up
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 113
stairs; dizziness and trembling before breakfast, headache;
throbbing in the centre of the brain ; nostrils plugged up with
yellow fetid scabs; swelling of the tonsils with constrictive
sensation when swallowing; dislike of his accustomed pipe;
sensitive condition of stomach and weakened digestion; nat-
ural stool every four or five days; scanty, blood-red urine;
tickling as from a feather in the throat which makes him hack
during the day, but causes such violent dry cough in the night
that it brings on violent beating of the heart and arteries; at
times he vomits after it, has difficulty of breathing and upon
deep inspiration violent stitches in the chest; uneasiness about
the heart; swelling of the cervical glands; pain in the small of
the back; constant and marked chilliness with great thirst;
great exhaustion, lassitude and sleepiness during the day; at
night profuse sweat on the chest which weakens him ex-
tremely; with it an unusual general prostration and appre-
hension concerning the state of his health.
Prescribed Calc. carb. 30 ; after a week, symptoms of improve-
ment, mind more cheerful, disappearance of sweats, tendency
to cough decreased and the cough became less dry ; he contin-
ued to improve until he considered himself well." — Translated
by Dr. Arndt.
Carbo vegetabilis. — The effect which Carbo veg. has upon
the respiratory tract as well as the digestive organs and lym-
phatic glands gives to it a wide range of applicability to our
jDulmonary affections. It has a catarrhal range, assimilative
range, a hemastatic power, and is a powerful eliminator of
effete matters, and has also an antiseptic influence, hence may
be adapted to recent and old catarrhs, bronchiectasis, hemop-
tysis and to cheesy decompositions when passing into a putres-
Indications : itching in the throat, hoarseness, rawness in
the larynx ; worse evenings ; morning aphonia in damp cool
weather; chronic hoarseness aggravated by wet weather, espe-
cially wet evening air, and by talking; voice fails unless there is
much exertion made to speak. Breath is short, with cold hands
and feet; desires to be fanned and calls for more air; the body
has hot flashes passing over it when coughing; cough is violent
114 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
by spells with a profuse expectoration as in bronchiectasis:
cough again is hollow and spasmodic ; worse in the evening
or before midnight; dry and painful, or attended, it may be,
with purulent, offensive slimy sputum. At times one feels as
if cough was caused by vapors of sulphur ; has a choking sen-
sation which is relieved by motion ; cough sometimes causes
stitching pain in the head; is worse on going into a cold place
from a warm room; from walking in the cold air, from lying
down, from eating cold food and drinking cold drinks; sputum
often tastes sour or saltish ; is of an unpleasant odor ; sputum
of different shades; whitish and tenacious, with a good per cent,
watery, brownish, bloody, yellow-green purulent; in the lungs
a heat as of glowing coals is set up.
Other and grave symptoms more properly given in another
" A lady caught cold fourteen days ago, has coughed for a
week; coughs worse by day and in the open air and during
supper; cough is continuous, dry and hard, with soreness of the
chest and heat of the body when coughing; sensation at night as
if there was mucus in the throat choking her when she coughs;
the choking is relieved when sitting up or on moving. There is
itching in the throat, extending into the chest, which is worse when
coughing. Carbo veg. cured the case." — E. W. Berridge.
Kali carbonicum. — Suitable to anaemic and hydremic con-
stitutions. Puffiness of the eyelids and stitches are among the
characteristic symptoms. There is mucus in the fauces which
is only removed by constant hawking. Cough is worse about three
o'clock in the morning. Eating and drinking aggravates the
cough. Is troubled about lying upon the left side. Heart symp-
toms apt to complicate the pulmonary symptoms.
"Miss G. P., fair blonde, set. 20; much mucus in fauces
which she is constantly obliged to remove by hawking; sharp
stitches in the eye while reading or sewing. Kali carb., three
doses daily, relieved the tedious affection very soon." — C. Wes-
Kali hydrojodicum. — The iodides of potash and arsenicum
both seem to be attracting considerable attention as curative
agents in catarrhs. The action of iodine as well as potassa
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 115
upon the respiratory tract would lead us to expect these re-
sults gained at the bedside of our patients. The specific ac-
tion also which Kali hyd. has to certain cachexias, such as
scrofula and syphilis, adds to its pledge of usefulness in many
cases which we shall meet in our practice. It may have more
power to arrest the progress of syphilis than scrofula, more
efficiency in removing the exudative product known as gum-
mata than tubercle, but that it has an applicability to both
constitutional states is admitted, and warrants us in testing
the remedy much more thoroughly than has yet been done.
And especially, in the potentized form, for acute catarrh and
secondary pneumonia as well as catarrh, with cheesy exuda-
tion and with syphilis. Among the indications for its use
will be found the following symptoms : catarrhal voice; hoarse-
ness with pain in chest ; oppression of breathing, ivith pain in
both eyes; sometimes eyelids are swollen; awakens with a chok-
ing sensation; can scarcely breathe; oedema of the larynx!
rough feeling in the trachea, compelling hemming and hawk-
ing; cough, with dry hawking; and later, expectoration of
copious green sputum; abundant expectoration of white froth,
resembling soap-suds; stitches from sternum through to the back
(Kali bich.), or deep in the chest while walking; purulent sputum
with exhausting night sweats ; loose stools ; oedema pulmonum
accompanied with morbus Brightii. Morbus Brightii, Ben-
nett says, frequently follows arrest of the degradation of
tubercle in the lungs.
" A. D. In consequence of a neglected cold, pneumonia fol-
lowed with hepatization of right lung. Bryonia, Sulphur,
Phosphorus, Rhus tox. and Bromium were tried to no purpose,
when Kali hyd. was given and followed by rapid curative pro-
gress. The most striking symptom being abundant expectora-
tion of white froth, resembling soap-suds" — W. E. Payne.
"P. R. P. After an attack of diphtheria had the following
symptoms: paleface; sunken eyes surrounded by blue rings;
expressionless countenance; oedema of the eyelids; deep hollow
cough with whitish expectoration; great prostration; tearing
pains in the limbs; loss of appetite; swelling of glands about
the neck; constant thirst; copious micturition; sleeplessness;
116 PHTHISIS PULMONALIS .'■ TUBERCULAR PHTHISIS.
nightly aggravations. Pronounced hopeless by attending phy-
sicians. Cured by Kali hyd." — Dr. D. F. Hunt.
Lycopodium. — A very efficient remedy in controling affec-
tions of the mucous membranes. It corresponds rather to the
dry form of catarrh than the fluent. To persons inclined to
emaciation and a weak peripheral circulation, it stands almost
foremost among all our remedies. The emaciation is more
noticeable in the upper 'portions of the body ; cold feet and hands
are among the more noticeable symptoms belonging to Lyco-
podium. The stomach and alimentary tract usually present
important symptoms if Lycopodium be the remedy, flatulency
being the most important. Patients sit down to their meals
thinking ihej can eat heartily, but are quickly filled; feel full
and pressed at the stomach ; food is apt to sour. Besides eructa-
tions we have pressure in abdomen from flatus. Cough is dry,
seeming to come from the stomach; is apt to be worse about
4 o'clock p.m. or a little later; is usually induced by a tickliug
sensation in the larynx; by lying upon the left side (Phos.,
Sepia) ; by eating and drinking cold things (Carbo veg.) ; by being
in the wind, and from the air of a warm room ; voice is hoarse,
husky and feeble, with the sense of dryness in the trachea;
the kidneys are another foci of expression, and we have brick-
dust deposit in the urine. Among the chest symptoms we find
continuous pressure and a raw feeling internally ; stitches in the
left side during inspiration. It has proved curative in cases of
neglected pneumonia when purulent expectoration has fol-
lowed hepatization, and in catarrhs which have continued un-
til complicated with cheesy exudation into the apices.
Dr. Pope says, "Few remedies are so valuable in pulmonary
phthisis as this when persistently used."
" A boy, set. 14 ; thin and weak ; but little muscular develop-
ment; mind active and of a sensitive nature; mother died of
consumption; has a hard, dry cough which is making him so
feeble he can but with difficulty stand; coughs all day and
night, even when asleep ; very violently in the morning ; res-
pirations very rapid and a quick pulse; voracious appetite.
Lycopodium 200 cured." — P. P. Wells.
" A girl, est. 15; has always been delicate; had pleurisy three
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 117
3 T ears ago; has also had sores on legs; healed now and since
has been worse; father and one sister died of consumption;
has pains shooting into right hypochondrium of long standing;
has a cough and raises a yellow sputum; pains shoot from
upper middle chest to back when coughing; short shiverings ;
likes to be near the fire; faint when undressing; clammy sweat
and feeling of coldness ; worse 4 and 5 p.m. ; fan-like motion of
ali when feeling worst. Cured by Lycopodium." — Berridge.
Mercurius corrosivus. — This and the proto-iodide are the
forms of Mercury which we have used chiefly in plastic exu-
dations. Mercurius cor. has a powerful influence in control-
ing albuminous exudations and glandular engorgements. It,
with Apium vir., is our remedy in morbus Brightii. In ca-
tarrhs, nasal, bronchial, intestinal and uterine, we have found
no remedy more frequently of service. The complications of
pulmonary affections with albumen urea, so common in phthi-
sis, will be better controlled by Mercurius cor. when the chronic
stage is reached than any other remedy so far as our experi-
ence goes. But we have always given the 200th dilution. The
secretions of the mucous glands which indicate Mercurius are
usually corrosive; patients are worse in damp weather; at night,
especially in cold, damp night air. Their symptoms are aggra-
vated by both cold and warm air, especially from getting warm
in bed. Patients are also inclined to perspire; sweat starts out
from the least exercise or from pain ; the sweating not affording
any relief; the head often feels as if it would burst or was grow-
Patient is hot and cold in alternation; salivary glands become
fluent ; gums have a whitish line running along the middle ; breath
fetid; parotids tender; perspiration often sour (Lycopodium),
comes out all over and suddenly, while Calcarea is more about
the head and feet, as is also Silicea, both coming out more
moderately. The cough is violent, often prevents one from
speaking; at least every attempt to speak provokes a violent
cough; head snaps; sometimes coughs till vomiting sets in;
there is tightness across the chest; stitches in the chest, mostly
in the lower right lobe.
Mrs. L, set. 37, sanguine temperament, subject to severe
118 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
attacks of catarrh, most troublesome in the spring; coughs
worse in the evening, in cold, damp weather and after getting
warm in bed; breaks out suddenly into a drenching perspira-
tion from slight exercise; is easily out of breath from walk-
ing; cough is provoked by any attempt to talk; is exceedingly
harassing, so much so that a drenching perspiration follows
the more prolonged attacks; troubled to hold her urine when
coughing. Merc. 200 cured promptly and permanently.
"B. R., eet. 8, of scrofulous diathesis, light complexion, had
ozcena for ten months ; much emaciated ; swelling and redness
of the nose ; nose stopped up ; scabs in nostrils ; loss of smell
and taste; discharge from nose like glue; tonsils large ; all the
symptoms are worse in the open air, especially damp, cold
air ; is worse also at night. Gave Merc. cor. with a rapid re-
covery." — Dr. D. F. Hunt.
Mercurius proto-iodide. — This remedy seems to combine
the properties of Iodine and Mercury. It is applicable to cer-
tain phthisical cases which have a catarrhal and scrofulous
origin. The same power which Mercury has shown in arrest-
ing albuminous deposits is exhibited in arresting the vascular
congestion so favorable to cheesy exudation. We have used it
more frequenthy perhaps, for catarrh of the nasal passages,
where the conjunctiva has sympathized, or even where there
have been ulcers upon the cornea. The septum has been
thickened, with soreness of the alas which are inclined to be
covered with crusts ; plugs are discharged from the nose which
are tinged with blood ; as the disease progresses downward the
tonsils become inflamed and enlarged; then the larynx and
trachea are attacked ; at this time we have hoarseness and loss
of voice; next a cough which is loose, rattling, with the bronchi
loaded with mucus as the catarrh travels onward, and the spu-
tum becomes copious and yellow. Patient is sensitive to cold
damp weather as in Mercury, and also worse in the spring.
There is a tendency to empty deglutition; hawking to clear the
throat of a lump ; perhaps gags while trying to clear the
throat ; appetite is variable with weak empty feeling at the
stomach ; sweats easily and suddenly as in Mercurius.
In some cases when the throat, nasal and eye symptoms of
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 119
a grave character have developed in constitutions where con-
sumption was hereditary, I have witnessed the best of effects
from this remedy.
B. E., set. 5, dark hair and black eyes ; mother died of tu-
bercular phthisis ; has been troubled with nasal catarrh for
two years ; thick, hard plugs form in the nostrils, which so
block the passages that he has to breathe through the mouth ;
scales come off with the plugs, leaving the mucous membrane
sore where pus-globules are seen on ulcerated surfaces. The
voice has a thick, broken sound with much of the nasal twang.
Tonsils are enlarged and respirations increased; snoring at
night in sleep ; coughs at night and raises a quantity of mucus
which comes up easily ; bridge of the nose swollen, the con-
junctiva apt to be red, especially if case is aggravated by a
cold. Vessels of the inner canthus of right side often throw-
ing out distended and reddened lines to the border of cornea
where an ulcer appears ; upper lip swells and glands of the
neck are also inclined to swell.
Mercurius proto-iodide 200 cured. — G. N. B.
Nitric acid. — So generally has mercury been used for many
years,' the constitutions of a large per cent, of our people have
been injured either directly, or from the condition the germ
has been found in, at the time the organic type has been prop-
agated. This multiplies diseases both of the throat and lungs
to which Nitric acid becomes appropriate. Besides we have
troubles of the throat which simulate a catarrh, but have
Such cases especially call for the use of Nitric acid. Both
the syphilitic and mercurial dyscrasia favor the production of
tubercle in that they degrade the blood and sap the vital forces.
We have met with several cases of phthisis which were de-
veloped out of syphilitic inoculation and mercury used to
control it. We do not say but that syphilitic products are dif-
ferent form tubercle pathologically, but we do say that we
have seen syphilization and mercurialization end in a caseous
exudation and cavities in the pulmonary tissue, which we
believe would not have occurred only for such syphilization
and mercurialization. There are also cases coming to us purely
120 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
catarrhal, to which Nitric acid is appropriate. Some of the
indications are coughing up a bitter or sour tasting sputum in
the morning, followed by greenish-white casts as if from the air-
cells; it is very common to have soreness of the larynx; a very
important symptom, when present, is a sticking sensation behind
the sternum, as if a sliver were caught there ; a strong ammoniacal
odor to the urine is often present in Nitric acid cases; sometimes
gastric troubles, such as nausea, which is better by riding in a
carriage; itching and eruptions at the anus are often met with
" A patient, set. 34, sandy complexion, blue eyes and excita-
ble, of a scrofulous habit, intemperate, dissolute ; been under
treatment for syphilis; called on me for ozcena; has an offen-
sive yellow discharge from the nose ; redness of the nose and
excessive sensitiveness to the touch; deep ulceration of the
nasal mucous membrane and of the soft parts ; loss of portions
of the septum. Redness in the posterior throat, which is cov-
ered with a dirty green slime and ulcerated in spots; sticking
pains in the nose and throat; sticking in the sternum; great
weakness; restless at night; peevish, irritable, despondent;
is troubled with constipation. Cured by Acidum nitr. 3 ." —
" Mr. L., set. 30, dark hair, light complexion, hardy constitu-
tion, applied to me for treatment of an obstinate catarrh ; a
year ago contracted a specific ulcer which after a time healed,
but was followed by constitutional symptoms, painless swelling
and induration of the glands, ulceration of the tonsils; the
discharge from the nose was fetid, salty in taste and frequently
copious ; upper portion of the nasal fossse and post-nasal cavity
most affected ; mouth aphthous. Nitric acid cured in the 2d
dil." — Morse.
Mrs. C. E. H., set. 45, slender and delicate, with brown hair,
blue eyes and sallow complexion, inclined to diarrhoea, to
eruptions about the outlets of the body; excoriating leucorrhcea;
ulceration in the mouth, particularly about the palate and
fauces, extending even to the pharynx. The throat symptoms
usually most pronounced. Nose a little sore, often discharging
a corrosive yellowish matter. Green casts discharged from the
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 121
nose usually in the morning. Sometimes patient is troubled
about getting choked at the table from, bits of meat; throat is
tender to touch, with raw feeling on swallowing ; prickings be-
hind the sternum as if a sliver was there. Coughs a good deal ;
cough mostly dry ; voice gets weak from talking. Slight dul-
ness of the apices and flattening of supra-scapular spaces.
Patient is making her menstrual climaxis. Mother died at
this period of her life from phthisis. The above case was suc-
cessfully managed with Nitric acid supported by Lachesis. —
G. N. B.
Stannum. — No remedy ranks higher for controlling old
bronchial inflammations that have run on till the tubes have
become thickened and narrowed in places and dilated in
others. The old-fashioned consumption which ran on for
many years till bronchiectasis with purulent and chemically
degraded matters, poured from these pockets, has been more
often cured by Stannum than any other remedy that we know
of. It is also an efficient remedy when we have complications
of the caseous degeneration into the apices. It does not corre-
spond to that high grade of febrile excitement which usually
attends Phosphorus and Sulphur cases, though we may have
the pulse run up very high. Weakness of the chest is the most
important and universal symptom ; tires out from the cough,
and by talking, in the chest. Sometimes feels like dropping
down almost helplessly into the chair. The second most notice-
able symptom is, the very large amount secreted by the mucous
membranes to be expectorated. The sputum is yellowish or
yellowish-green with much glairy mucus holding the yellow
part in its meshes; or it may be chiefly of the yellow cast and
in heavy, distinct mouthfuls. At times we have a dry cough
of a hacking, teasing nature which Stannum will cure. Pa-
tient coughs mostly in the evening after lying down. Stannum
sputum usually has a sweetish taste; sometimes it has a saltish
taste. The cough is worse from lying on the right side (reverse
of Phos. and Lycop.) ; profuse sweats attend our graver cases,
the sweat smelling mouldy or musty, and appearing on the
neck more than elsewhere ; fever apt to appear in the after-
noon from 4 to 5 p.m. (Lycop.) ; chill at 10 a.m. (Natr. mur.) ;
122 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
hands burn when fever is on. Many of the symptoms gradu-
ally increase and decrease. We give a few typical cases, some
of which it is more than probable had tubercular complica-
tions but the physical diagnostic symptoms are not given.
" M., set. 36, has suffered since spring from catarrh and lung
trouble. On August 4th, I found the following symptoms,
which had existed for a month: his teeth seem loose and too
long; much phlegm in the throat; morning and night a
scratching sensation in the throat ; roughness in the throat ;
cough provoked by tickling; cough with greenish expectora-
tion of disagreeable sweetish taste; worse in the evening;
hoarseness; in the evening oppression in the chest, with anx-
ious apprehension ; asthma ; cannot get breath when making
a slight motion, and he is often obliged to unbutton and open
his vest to get a chance to breathe; stool greenish and scanty;
great burning of hands and feet; lassitude of the entire body;
very weary and sleepy ; profuse sweat every morning after 4
o'clock; emaciation; the patient is indisposed to talk; takes
no comfort in anything and is discouraged. Cured perma-
nently in three weeks by Stannum 3 ." — Schreter, in Ann. I,
" M., set. 37, has been sick for two years; hereditary consump-
tive habit; unsuccessful allopathic treatment. Symptoms:
patient very pale and emaciated; breathed short and quick;
coughed often; dry, or followed by copious greenish-yellow, sweet
expectoration, especially morning and night; stitching headache,
especially in the forehead; worst after coughing; appetite increased,
with subsequent pressure in the stomach and scanty stools;
heaviness and coldness of hands and feet, with slight oedema;
in the evening flushes of heat and thirst. Cured by Stan-
num 18 in repeated doses." — Schubert, in Prakt. Beitr., I, 119.
"H., tall, thin, of consumptive habit; set. 50. Ten years ago
had endocarditis and pleuritis. Was taken sick again a few
weeks ago. Symptoms: lassitude; pain in every limb; con-
stant irritation to cough; repeated shivering during the day,
and profuse perspiration early in the morning in bed,; is now
confined to his bed; cough uninterrupted ; constant; expecto-
ration of astonishing quantities of tasteless, white mucus; un-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 123
quenchable thirst; great desire for sour milk; allopathic treat-
ment unsuccessful. Stannum 6 , followed by aggravation then
cure."— Gross, in Arch. XVIII, 2, 61.
"A stout, thickset man, set. 54, was taken with prurigo, and
in consequence of the continued scratching had eventually an
ulcer on the leg, probably result of heroic treatment. Includ-
ing of course the due amount of anointing him with salves,
his condition became thoroughly broken down, and he suffered
from digestive troubles, jaundice, asthma, etc. At last cough
set in, with tickling in the throat; loss of appetite; fever;
drenching night sweats. Deglutition of fluids became more
and more difficult, causing suffocative paroxysms with violent
coughing; expectoration increased in quantity; at first slimy,
then pus-like, averaging daily more than a pound; hoarseness;
emaciation; the epiglottis covered with pus; margins ulcer-
ated; death was expected hourly. Stannum 6 , one dose, was
followed by a night's good sleep, the first in two years. Visi-
ble improvement during the next few days, and complete cure
in a few weeks." — Clotar Mueller, in Pr. 31. 8., VII, 2.
For a more exhaustive discussion of the treatment of catarrh,
the reader is referred to our work upon " Catarrh of the Nasal
and Respiratory Organs."
We think a careful distinction should be kept between pul-
monary phthisis and pneumonia proper. But it is equally
important that we recognize the fact that the deposits of pneu-
monia may become transformed into cheesy products which
are likely to break down the lungs and open up cavities ; that
the presence of undissolved and unabsorbed products so de-
posited are a source of irritation keeping up a sort of chronic
inflammation which favors the tubercular deposit or cheesy
exudation. This continued pneumonitis is a menace, espe-
cially to all persons with any predisposition to phthisis or even
124 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
persons of a low vitality, if not of itself a cause sufficient in all
particulars to bring about tubercular deposit and the fatal
consequences following. Perhaps this is more fully manifested
in interstitial pneumonia or where chronic inflammations
follow infarctions and blood extravasations. The clinical re-
cord given in this chapter presents cases for the most part
coming from croupous and lobular pneumonia of rather recent
Pneumonia is treated of under the terms catarrhal pneumo-
nia, croupous pneumonia and interstitial pneumonia. In ca-
tarrhal pneumonia we have a bronchitis extending to the
alveoli and from there to the parenchyma ; it is what has often
been termed lobular pneumonia, because it affects the lung in
a more limited way than fibrous or croupous pneumonia. It
may diffuse itself all over the lungs in the form of isolated in-
filtrations ; it is a disease especially of young children and of
old age ; yet it occurs at other periods of life. The physical
diagnosis is not easily made out from the fact that there are
apt to be pervious alveoli so near the occluded cells that we get
resonance too well marked to be able to decide on condensa-
tion. We judge more from the sounds indicating a capillary
bronchitis, from the retraction of the lower ribs during inspi-
ration and from the absence also of critical periods and fluc-
tuations which usually attend other varieties of inflammation
of the lungs. The condensation proceeds slowly and from
below upward usually. It is important that the alveoli be
cleared and all condensation be removed before discharging
such patients or we may have as the sequel, pulmonary
Croupal Pneumonia or Fibrous Pneumonia. — This disease is
what most authors usually mean in speaking of pneumonia.
It more often attacks the right side and begins in the lower
lobe ; the inflammation probably begins in the minute bron-
chioles and the alveoli at the same time, throwing out . a fibri-
nous exudation upon the mucous surfaces. By this means
we get the vesicular murmur so characteristic of the disease.
As the inflammation extends, the alveoli become blocked and
the parenchymatous tissue is attacked, occasioning the conden-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 125
sation known as hepatization. We have resolution by absorp-
tion of the adventitious products, or there remains a perma-
nent condensation which later may take on tubercular com-
plications. The case also ends more rarely by purulent or
gangrenous degeneration called the third stage belonging to
the acute attack. This form of pneumonia usually sets in
with a severe chill followed by intense fever; the pulse runs
up to 100 or more, the temperature to 104 or 105 in the even-
ing, dropping from one to two degrees in the morning. Res-
pirations increase from twenty to forty or more per minute ;
this would indicate an active pneumonia. The dangers arising
from this form of pneumonia cannot better be stated than by
inserting what Rokitanski has written. In speaking upon tu-
bercle as it affects the lungs he makes two classes of cases ;
one class derived from " interstitial tubercular granulations"
which is the millet-seed variety, and deposited, as he says, in
the interstitial cellular tissue between the smaller lobules and
the air-cells ; and the " infiltrated tubercle," which, he says, is a
deposit made in the air-cells themselves. The infiltrated tu-
bercular invasion of the lungs he makes to come from croupous
pneumonia. This is his language: "It (infiltrated tubercle)
results from a croupous pneumonia of various extent, which
deposits its products, and these, under the influence of tuber-
culous dyscrasia, become discolored and changed into yellow
tubercle, instead of being absorbed or changed into pus. Hence
tubercular infiltration is a hepatization formed by a tuberculous
exudation, the pneumonic, originally red and granular struc-
ture of which gradually becomes paler and grayish-red, with
a tinge of yellow; it is then dry and fragile, but finally it be-
comes yellow, moister, of fatty cheesy consistence, and breaks
down sooner or later into tubercular pus."
Raue, after speaking of the usual course of pneumonia, says,
" or the hepatization changes into tubercular infiltration which
is especially the case when the seat of inflammation is in the
upper region of the lungs. In such cases the fever does not
leave altogether, but shows an aggravation every night; cough,
dyspnoea and dull percussion sound of hepatization continue,
while auscultation reveals bronchial breathing and bronco-
126 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
phony." It is not always the case that this fever and cough
keep up ; patient recovers from all apparent inflammatory ac-
tion, but there is left a hepatized lung. After a time this hep-
atized lung breaks down and we have abscesses of the lungs ;
but before this, more frequently there is associated with hepa-
tization tubercular exudation provoked by the irritation and
chronic inflammation which this hepatization causes. More
often, perhaps, pneumonia has been developed in persons pre-
viously predisposed to tuberculosis, and it has been a provok-
ing cause of tubercular exudation and the subsequent breaking
down of the lungs by abscesses. Pathological anatomy reveals
not unfrequently traces of pneumonia, and the ravages of
tubercle in the same lung and set up together. These facts
urge upon the profession the necessity of thoroughly mastering
their cases of pneumonia, especially should those with tuber-
cular tendency be watched. We have observed where persons
were subjected to repeated attacks of pneumonia that they
usually died of consumption in the end. It may be a question
if this inflammatory diathesis is not closely allied to the tuber-
cular diathesis. Excess of fibrin in the blood is found in each
class of these cases. Certain it is, that pneumonia only par-
tially arrested, is the beginning of a retrograde action which
but too often ends in consumption ; old hepatizations become
burrowing places for fatal abscesses and gangrenous degreda-
tions ; constricted capillaries, the seat of imperfect circulation,
and later, the place of cheesy deposit and tubercle.
Here will be a class of cases where Lycopodium, Phosphorus,
Sanguinaria, Silicea, Stannum and Sulphur will find an ap-
plicability. The means at a homoeopathic physicians hands
are somewhat illustrated in a few cases we will give, taken
from our note book and from journals.
A Miss Green, set. 13, of a nervous sanguine temperament,
was attacked with pneumonia in the apex of the right lung,
which became infiltrated through the entire upper lobe. Pa-
tient had been attended about eight weeks, by two allopathic
physicians, and case had reached the condition of hopeless-
ness in their opinion as stated to us by friends. " Galloping
consumption " was the diagnosis. We found patient troubled
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 127
with severe dyspnoea; had to have the windows up; could
only breathe by being elevated to an angle of 45 degrees,
and had to lie turned upon the right side ; respirations 60 per
minute and pulse, 160 ; dry, hot skin, and a constantly annoy-
ing, dry, hacking cough; more severe in the morning and
evening. Gave patient a dose of Sulphur 20m , Fincke, and put
her upon Phosphorus 290 . Slight abatement of fever and cough
in twenty-four hours. Treatment continued with signs of ex-
pectoration at the end of thirty-six hours. Very free muco-
purulent expectoration in sixty hours, continuing till apex of
lung was cleared. Lung in clearing up showed signs by phy-
sical examination of being badly riddled, but healed kindly
in two or three months, and patient was fully well in six
months. The only other remedy given was Pulsatilla, for
some symptoms connected with puberty. We are very posi-
tive that in this case there was caseous infiltration. The apex
of the lung was the principal seat of deposit, and the case at
the time of our visit was one which very properly should be
called acute phthisis, though beginning, as we suppose, with
croupous pneumonia. — G. N. B.
A Mrs. Seymour was attacked with croupous pneumonia at
the age of 50. She was of a nervous bilious temperament,
dark hair and eyes, and quite spare; had been treated a week
by a homoeopathic physician who had relied on Bryonia and
Tartar emetic. Found her with a dry, harassing cough, hardly
expectorating at all, with a sense of tightness across the chest ;
countenance livid; eyes glassy and dull in appearance; con-
junctiva yellow, with a marked yellowish tinge all over the
face; urine brown and somewhat scanty; vital forces nearly
overwhelmed; patient cachectic and ansemic. Gave Sulphur 200 ,
and put her on Phosphorus. Patient made a good recovery.
This was an unusually severe case of pneumonia, occurring
in a weak constitution. A very dangerous case but was
hardly one of tubercular complication, yet likely to end so un-
less anticipated by a fatal termination. — G. N. B.
A gentleman of a sanguine temperament taken with a pneu-
monia which did not yield kindly to the usual remedies, pre-
sented on the tenth day the following symptoms : high fever,
128 PHTHISIS PULMONALIS: TUBEKCULAR PHTHISIS.
dry cou gh and circumscribed red cheeks, almost livid; mutter-
ing delirium and dyspnoea; pulse easily compressed. Gave
Sanguinaria with curative results. Patient was of a phthisi-
cal family.— G. N. B.
A young man, set. 20, of a bilious temperament, had an at-
tack of pneumonitis ending in chronic pneumonia; was
treated five months, having two homoeopathic physicians from
whom he took many things. When coming into our hands
we found dulness in upper right lobe and bronchial murmurs.
He was harassed with a dry cough, aggi avated by going into the
open air; inclined to press on the chest when coughing, and to
bend over; pulse 130; respirations 35 to 45 per minute, with
night sweats. Our prognosis was unfavorable, but gave him
a dose of Sulphur 20m , followed with Phosphorus 200 , night and
morning. Sulphur again in a week and continued Phos-
phorus. Lungs cleared up rapidly and cough passed away in
six weeks, leaving patient entirely well and free from all dul-
ness on percussion. In this case there was infiltrated tubercle
beyond doubt. — G. N. B.
E. C, set. 25, of nervous lymphatic temperament, suffering
from intractable pneumonia, resolution not being accomplished
at the fourteenth day. At this time the symptoms were:
sunken eyes; sallow complexion; cough mostly dry and very
fatiguing, causing pain in the stomach and seeming to start from
the epigastrium ; much dyspnoea and something of the fan-like
motion of alae nasi; evening aggravations. Gave Lycopo-
dium 200 . Patient made subsequent improvement to recovery.
— G.N. B.
" A woman, set. 60, had pneumonia (right side) three years
ago ; later an acute bronchial catarrh aggravated by acute
gastritis. Symptoms: cough which gives her no rest at night;
patient is obliged to sit up in bed and cough all night; usually
dry; often as convulsive and continuous as whooping cough,
with pains in both hypochondria and right thorax above the
liver; during the cough stitches, so that the patient is obliged
to make hard pressure upon the chest with both hands, and
soreness of the pit of the stomach to touch, with oppression of
the chest; pressure and fulness in the right side of the chest;
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 129
after protracted coughing the entire abdomen is sore ; coughs
day and night; in the morning the patient raises thick, heavy,
purulent matter; she is exhausted, emaciated; has no' appe-
tite whatever; the cough is increased by talking and cold air;
no fever. Gave Phosphorus 30 . Four doses completely re-
moved the symptoms. Later, if she coughed at all, there was
an entire absence of purulent matter or blood." — Knorre,
Allg. Horn. Zeitg., XIX, 288.
Dr. Lorbacher reports a case of interest, where there was a
complication of cheesy pneumonia and infiltrated tubercle.
"American, set. 19, of tall stature, with decided predisposi-
tion to phthisis. Patient took cold in January and came to
us in April. Physical examination showed the upper right
lobe obstructed over a large space; there was marked dyspnoea
on walking, and especially from ascending stairs, accompanied
with lancinating pains ; recently an evening fever had set in,
followed by profuse night sweats; bowels were loose; appetite
poor, with steady loss of flesh; cough chiefly of a dry charac-
ter, excepting in the morning, when there was a copious ex-
pectoration of a greenish-yellow matter; chest symptoms ag-
gravated in open air, and sputa frequently had a tinge of blood.
Phosphorus 30 , dose every other evening for two months effected
Another typical case from our own note-book is that of
Charlie Bojmton, set. 4; light complexion; soft fibre; blue
eyes and of scrofulous predisposition; was attacked with in-
flammation of the lungs, in February, 1868. Family physician
called and managed the case till he was baffled, and told friends
there was no hope, as the boy was dying of quick consump-
tion. Found patient terribly emaciated, with a high fever,
small, quick pulse, and constantly harassed with a dry cough
exceedingly bad to bear; chest, upon the right of the median
line badly flattened and contracted, so as to give a concave ap-
pearance, the centre of depression being at the middle of the
sixth rib ; patient was w 7 eak and irritable, crying out and com-
plaining at almost every attempt at coughing; considerable
space over right lung was dull on percussion; patient had to
lie bent upon the right side; cough harasses him all day,
130 phthisis pulmonalis: tubercular phthisis.
rather worse early in the morning. The pneumonitis was in
lower lobe in this case, but probably we had infiltrated tuber-
cle. A few doses of Bryonia, followed with Phosphorus 30 and
continued three weeks at diminishing intervals, brought about
decided improvement; and Phosphorus 200 continued, a dose
once in two days for three months, brought the child com-
pletely out of all this trouble; flattening and curving of the
chest, all dulness and the cough entirely disappearing, while
flesh and advance in growth took the place of extreme ema-
ciation. There was never any great amount of sputum ex-
pectorated; everything obstructing the free action of the lung
being carried away by absorption. — G. N. B.
"A furniture maker, set. 35, of well-defined tuberculous dia-
thesis has had yearly attacks of pneumonia under the care of
a " regular " physician. From the last attack he did not rally.
Symptoms: the throat was raw, hoarse and dry; the chest felt
to him as if filled with pus ; the cough was very exhausting,
causing him to tremble all over; the violent stitching pain in
the chest had left him, but there was much general irritation
throughout the chest; the yellow, pus-like expectoration tasted
salty and was most copious in the morning and evening; the
eyes were unsteady and he could hardly speak a word without
being interrupted by short, harrassing hacking; constant chil-
liness, especially toward evening, interrupted by flashes of
heat; at times he complained of tearing and stitching pain all
through the chest; again the pain seemed beating, or the whole
chest seemed raw and greatly oppressed ; he had night sweats
and tumbled all night on his couch of shavings. After having
been treated by the "regular" attendant he received Phos-
phorus 30 ; on the third day he was more comfortable ; on the
fourth he had some sleep ; after a week the hoarseness and
nightly fever disappeared ; his voice became stronger and he
improved gradually and sufficiently to again perform his ac-
customed labor." — Hernpel and Arndt's Materia Medica, from
Bethon in Annal. d. Horn. Klinik., 1, 340.
Frank Nixon, set. 22, tall, pale, of lymphatic temperament,
prominent shoulders and flattened chest; family scrofulous
and had a brother die with pulmonary phthisis a year ago.
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 131
Had an attack of croupous pneumonia in May ; attack was
upon the left lung, involving both the apex and middle lobe.
Case was treated by the dominant school till abandoned as
hopeless. At our first visit we found patient lying upon the
back, with sunken eyes, and looking dark about the lids ; eyes
lustreless, pulse 140, respiration 35 per minute; perspiration
was standing on face and the whole body was drenched ; per-
spired upon the slightest exercise; the feet were swollen, no
appetite and little thirst. Accompanying these symptoms, a
violent, racking cough, worse at night, and worse from lying
upon either side; expectoration of large quantities of glairy
mucus intermingled with a reddish-yellow, or brownish-col-
ored sputa of putrid odor. Gave Mercurius 200 . Next day per-
spiration less and cough is less exhausting; continued Mer-
curius ; third day, drenching perspiration nearly gone ; urine
heavily loaded with brick-dust deposit. Gave Lycopodium 200 ,
and kept patient upon it until his recovery was completed,
supported occasionally with a dose of Cinchona 30 . The reason
for giving the Cinchona being debility from the long drains
occasioned by excessive sweating and copious expectoration.
Patient discharged in eight weeks free from any indications of
condensation in the lung tissue, and had gained his usual
weight of 180 pounds. His mother at this date is suffering
from an ovarian tumor upon the right side, and we have just
cured a younger sister of amenorrhcea from anaemia. — G. N. B.
The cases given in the clinical report show what can be
done with croupous pneumonia when attacking scrofulous and
phthisical constitutions when remedies are well chosen. There
can be no doubt but that tubercular infiltration was fairly set
up in a portion of these cases, and they are all of a sufficiently
grave character to be worthy of study. For the usual treat-
ment of this disease, in its more acute stage, the reader is re-
ferred to accredited text-books upon pneumonia.
Interstitial Pneumonia. — Rokitanski in speaking of this
disease remarks that as a rule it is not correctly described in
works upon pathological anatomy, as it is usually regarded as
a chronic form of croupous pneumonia, whereas the true seat
of the inflammation is the interstitial cellular tissue. Possibly
132 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
the walls of the air-cells may become affected by the extension
of the inflammation so as to involve them, when we would
have a complication of the croupal form added to the intersti-
Interstitial pneumonia is always chronic in its character, or
almost always at least ; it commences as an inflammation in
the cellular element, situated in the interstices between the
lobules and the smaller groups of the air-cells, and the inflam-
mation throws out an albuminous product which becomes or-
ganized and coalesces with the interstitial cellular tissue, so as
to form a dense cellulo-fibrous substance which obliterates the
air-cells by compression. This is so analagous to the process
of tubercularization, as described by Bennett, that one can
well conceive that the ground, by such an inflammation, is
prepared for the sowing of tubercle. Its most common seat is
the apices of the lungs, as is the case with caseous exudation.
The above quoted authority regards that it more commonly
arises out of the reactive inflammation which sets in around
apoplectic effusions into the lungs, lacerations of the lungs,
and pulmonic abscesses ; and to this he adds tuberculous cavi-
ties and gangrenous destruction. Interstitial pneumonia then
prepares the way for tubercular occupation of the lungs, and
also favors the extension of tubercular infiltration when once
set up at any point in the lungs. The importance of recog-
nizing this fact is very material, though often difficult. It
will be conceded that we have most ample means at our hands
for controlling pneumonic inflammations. If our cases of
hemoptysis have been well managed, we shall avoid many
cases of interstitial pneumonia, and to the treatment of hemop-
tysis we have devoted an entire chapter. But having a case
of interstitial pneumonia to deal with, we shall be obliged to
study for indications with great care as in the treatment of
other difficult diseases. Bryonia, Iodine, Iodide of mercury,
Lycopodium, Mercurius corrosivus, Myrtus communis, Phos-
phorus and Sulphur we mention as the more probable remedies
where the homoeopathic correspondence will be found. These
can be studied in detail, as well as the special chest symptoms,
in Hering's Condensed Materia Medica, Rane's Pathology and
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 133
Therapeutical Hints, and for the most part in subsequent chap-
ters of this work.
COMPLICATIONS IN PHTHISIS.
Pharyngeal Complications. — In granular pharyngitis we
have the caseous deposit, not very dissimilar from the caseous
deposit in phthisis ; also the calcareous deposit the same as is
found in the tuberculated lung. Drs. Sappey and Robin re-
port the histological changes to be thus : " The tubules of the
follicles were found considerably enlarged, both as regards the
diameter of their cavity and the thickness of their walls. In
the follicles which were most hypertrophied and indurated,
small calcareous concretions were discovered, composed prin-
cipally of the carbonate of lime; in some of the glands these
w T ere numerous and packed together so closely as to present
when detached, a crystalline appearance, owing to their sur-
faces having been moulded into polyhedral faceted figures.
The diseased glands appeared to be less vascular than in the
healthy pharynx; the cheesy secretion appeared to consist of
the debris of epithelial cells, of molecules and oil globules."
The similarity to the histology of tubercle in the lung is suffi-
Dr. Green thinks phthisis may take its origin in granular
pharyngitis, while Dr. McKenzie thinks not, but gives the re-
sults of observations made by Frankel in a case of actual
phthisis with tubercular ulcers in the lateral walls of the
pharynx, on the roof of the mouth, extending to the nasal por-
tion of the posterior wall of the pharynx, and on to the velum
palati; but these are said to cease abruptly at the opening of
the oesophagus. It is said the base of the ulcers were found to
be occupied by a thick infiltration of what appeared to be round
cells, extending deeply into the sub-mucous tissue, often even
as far as muscular tissue. The round cells also infiltrated the
connective tissue of the glands but did not invade the special
134 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
gland cells, which usually appeared to be in a state of fatty
degeneration. He further says, they have a tendency to be-
come cheesy. Both lungs exhibited cheesy broncho-pneumo-
nia and gray nodules. A cavity was also found in the left
lung. Tubercles were found in the pleura, liver and spleen,
and tuberculous ulcers in the intestines. We do not attempt
to settle the difference in opinion between these two gentlemen.
Dr. McKenzie adds, "Tuberculosis of the pharynx appears to
have been generally confounded with syphilis, and to this fact
the comparatively scanty amount of clinical observations is
probably due." " The lenticular ulcers of pharyngeal phthisis,
with the development of gray nodules in their neighborhood,"
he makes very characteristic of tubercle.
Tubercular Affections of the Larynx. — The cause of tu-
bercular deposit in the larynx is not as yet fully settled by
the medical profession ; some insisting that it is the poison of
the sputum coming from tuberculated lungs (auto-infectious),
while others think it to be in the main the same cause which
occasions tubercle of the lungs. Heinze has given us an ex-
haustive monograph which leaves little more to be said upon
questions of etiology and pathology. From the fact that tu-
bercle is occasionally found in the lungs, if found in the larynx,
and with indications of being an older deposit in the lungs,
the inference is that it spreads to the larynx as the disease
progresses in the lungs, and as the development of the ca-
chexia goes on. It is a fact that the lungs will usually be
found infiltrated if we have tubercle of the larynx. McKenzie
makes the broad statement that " In the case of adults, at least,
tubercle is rarely, if ever, found in any organ or tissue of the
body, unless it has been previously deposited in the lungs."
Men are more often affected than women, and the vigorous
period of man's life, from twenty to forty, is the time at which
the disease is most common. This may suggest the influence
of catarrhal attacks in multiplying these cases. It may also
suggest questions pertaining to the virile powers of man.
Louis, who maintained that the pulmonary sputa was the
chief cause of tubercle in the larynx, was compelled to admit
that the ulceration bore no relation to the irritative quality of
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 135
the expectorated matter. The fact also that the ulcers are
scattered about in the laryngeal mucous membrane goes to
disprove the theory that the sputum is the sole cause of the
ulcers. It is pretty safe to say that anything which tends
to produce weakness or chronic inflammatory action in the
larynx, tends to bring on a condition favorable for a tubercu-
lar attack, if the scrofulous cachexia exists.
Many persons date a laryngeal phthisis to a severe attack
of catarrh; others to overwork of the vocal organs. Heinze
thinks tubercular infiltration of the larynx occurs in about
one-half the cases of phthisis pulmonalis. The parts affected
are the ary-epiglottic folds, the epiglottis, the ventricular bands
and the vocal cords; the first two being more often affected it
is thought, and more extensively thickened by the deposit.
Chronic oedema almost always attends the tubercular deposit.
Thickening always attends, and ulceration on the cadaver has
been found in about one-fifth of the cases examined. The
epithelium does not seem to be much affected till ulceration
takes place. " The deposit," says McKenzie, " consists of tuber-
cles which are made up of more or less circumscribed collec-
tions of cells of various shapes and sizes, having a somewhat
concentric arrangement upon a scaffold of lymphoid reticulum.
The tubercles, some very small and some as large as a millet-
seed, have frequently in their centre a giant cell, around which
are lymphoid cells, and some few larger cells with nuclei of
high refractory power. The tubercular deposit is found both
in the mucosa and the sub-mucosa, but always above the layer
containing the mucous glands."
This goes to prove that miliary tubercle is usually associated
with caseous degeneration of the lungs. Ulceration is the
common sequel of tubercular deposit in the mucous membrane
of the larynx, provided the patient lives long enough. Some-
times the tubercular deposit begins in the glands, the round
cells deposited in the interstices between the acini gradually
crowding upon the membrana propria and leading to the de-
struction of acinous structure, so that a capsule which ordi-
narily would contain thirty acini, perhaps is found to hold no
more than half a dozen. At last the capsule is destroyed and
136 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
there only remain isolated portions of degenerate gland struc-
ture. The ducts have a greater power of resistance and may
be found intact. The blood-vessels, including the capillaries,
have the same power of resistance. This is the ordinary course
of the ulcer.
Tubercle is very seldom detected in the muscular structure,
but Heinze found among his many autopsies two cases where
they were present, and Frankel found fatty degeneration of
the contractile tissue and corpuscles in muscular structure.
To sum up: the semi-solid pyriform swellings of the ary-
epiglottic folds are the most characteristic lesion to be found,
and may be regarded as almost conclusive if found. Yet there
may be tubercle and not so well-defined a thickening exist. If
doubt is felt, an auscultation of the thoracic walls may settle
the point, for if tubercle be found in the lungs, the probabili-
ties of tubercle in the larynx would be very great. If auscul-
tation gives negative results, the sputa should be examined to
see if any elastic lung tissue is expectorated.
The diseases with which it may possibly be confounded are
chronic oedema, chronic laryngitis and syphilis of the larynx.
If chronic laryngitis, the swelling is usually less than if tu-
bercle be present, but there is more hyperemia; in oedema
the transparency is more apparent from the excess of fluids;
yet in the later stages this is of less importance as a differentiat-
ing symptom, for the reason that oedema often exists there as
the result of tubercle. In syphilis there is less regularity of
the hypertrophied tissue, and the ulcers are larger in size and
more solitary. They commonly surround a red, inflamed ring
— more often two are upon one side. In phthisis, the ulcers
are small, numerous, scattered, and a pale ground-work is
seen where they are sown. The hyperplasia is more uniform,
is smooth and even. If syphilis assails the epiglottis, for in-
stance, the free edge and upper surface is usually the place at-
tacked, while tubercle is more frequently found on the under
Ulceration of the arytenoid cartilages from syphilis is very
rare, while from tubercle it is most frequent. Both diseases
may attack the vocal cords, but syphilis usually attacks but
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 137
one cord, while phthisis will be likely to attack both. Again
the extent of tissue broken down is likely to be much more
from a syphilitic ulcer than from an ulceration following a tu-
If phthisis and syphilis be conjoined, of course obscurity
and doubt must increase.
The known effects of Bromine, Causticum, Iodine, Kali
bichromicum, Kali hydrojodicum, Lachesis, Mercury and Nit-
ric acid, suggest them as remedies to be consulted in this com-
plication, either as adjunctive to some constitutional remedy,
or as likely to be the agent meeting the entire similimum.
That tubercular affections of the throat have often been
overlooked upon the presumption that syphilis was present, is
more than probable.
That we have syphilis complicating many cases of pulmo-
nary and laryngeal phthisis, admits of no doubt. To analyze
and so separate these factors so as to give proper value to each
dyscrasia is exceedingly important. It is now well known
that we have syphilis pulmonalis as well as laryngeal syphilis.
The work of disintegration in syphilis in both places goes
on more slowly and with less acute constitutional symptoms.
The febrile excitement and the rapidity of tubercular degener-
ation as compared with the progress of syphilization ' is im-
portant in diagnosticating our cases; and our treatment will
be modified as we decide upon the presence of the one or the
other or both dyscrasias.
Intestinal Complications. — We have tubercles sown in the
mucous membranes of both the large and small intestines,
more particularly about the ileum. The glands here often
become so studded with tubercular deposit that the membrane
becomes a thickened mass, greatly narrowing the caliber of
the tubes. Sometimes the inflammation will, by its action upon
the muscular and serous structures, produce such contraction
as to almost amount to a stenosis. More frequently the tuber-
cles are found to attack the aggregated glands than otherwise ;
but you may see here and there a solitary yellow tumor not
larger than a hemp-seed projecting from the mucous surface,
not involving to any great extent the bowels, but yet showing
138 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
that this is proper soil for the lodgment of such seed. As
ulceration goes on, you will see a ragged border around the
ulcerating centres, where glands are being broken down.
Louis found tubercle in the intestines in a larger part of the
fatal cases inspected, dying from pulmonary phthisis. It is
usually regarded that tubercle in the intestines is secondary
to its deposit in the lungs. I am not sure but there may be
exceptions. The diarrhoea attending ulceration of the intesti-
nal tract in these cases greatly tends to exhaust our patients.
Tubercle in the intestines must also greatly impair the nutri-
tive functions. We know of no better remedies in these cases
than Calcarea carbonica, Calcarea phosphorica, Silicea and Sul-
phur, though the characteristic indications must be followed.
We have seen really very wonderful effects from Calcarea
carbonica, and make a clinical point for its use. What the
nosode Tuberculinum may be able to do, we are not able to
say; but it is well to remember that we have a similar prepa-
ration of the carbonate and phosphate of lime. The stomach
also is apt to become enlarged and thinned out in its walls in
the progress of a phthisis. I do not know as this indicates
anything more than a wasting of tissue as occurs through the
general system, and weakness of the muscular structure. But
the fatty degeneration of the liver found so often must have a
significance. Some regard the fatty degeneration almost pecu-
liar to this disease. The gland enlarges and becomes full of
adipose matter ; the whole gland loses its natural color and
becomes pale and soft in consistence. This indicates a change
in transformations, or arrest of fatty matter in course of desti-
nation for fulfilling some important function in the animal
economy. I suggest whether these may not be the cases where
Phosphorus is found to act so favorably.
The generally accepted theory that the bile and pancreatic
fluid are the chief solvents of amylaceous matters, may lead
most to think that partial arrest of the functions of the liver
and pancreas growing out of a general debility following the
progress of a phthisis, is sufficient to explain this fatty degen-
eration. But we have debility in ansemia, in continued fevers,
and in many other diseases without this fatty degeneration.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 139
I think we will have to look further for the cause of this
Whether this presents an abortive attempt of nature to set
up a curative process we do not pretend to say.
The need of fat to make blood-corpuscles has led most phy-
sicians to giving oils and amylaceous food to consumptive pa-
REGIMEN, CLIMATE AND SURGICAL DRAINAGE.
Before entering upon the analysis of remedies found in the
Materia Medica there are some therapeutical adjuncts to which
it may be profitable to give attention ; among these are cloth-
ing, food, climate and surgical drainage.
We have laid great stress upon thorough removal of extra-
neous matters from the system, such as the carbon and nitro-
gen products, and indeed, every other component of the excreta.
We have spoken of the importance of filling the lungs at the
time of inspiration if we would avoid mechanical blocking up
of the air-cells, and obstructions in unused portions of the
lungs, and have said that the oxygen received is indispensable
to the work of transformation perpetually going on in the
It is not saying too much when we affirm that a compressed
lung is a perpetual menace upon life.
How many dress so as to give absolute freedom to the lungs,
especially of the fair sex? Pressure could hardly be applied
to better advantage than by forcing up from below after the
manner of the corset. There is not space enough left in the
thoracic cavities to expand the whole of the lungs; the pres-
sure will be most effective at the apices, and it is just here
where we most frequently find tubercle. Not only should
pressure be taken off, but the muscles which lift the thoracic
walls should be educated and developed, so that by their con-
tractile energy the walls will be kept off from the lungs them-
140 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
selves. All curvatures of the spine, all contractions of the
chest should be promptly attended to, as having a tendency to
impair the respiratory function by compression. Systematic
and trained muscular movements, also systematic thorough
inflation of the lungs cannot be too strongly urged upon
those having any tubercular tendencies, always to be used ac-
cording to the power of endurance. Then surgical appliances,
such as the plaster of Paris splint, or felt jacket may be
necessary adjuncts if we have curvatures to overcome. Such
cases will be benefited by constitutional remedies, such as
Calcarea and Silicea; the diet also should be nutritious and
easy of digestion. Not only should the clothing about the
chest and stomach not compress the central vital organs, but
it should be of good non-conducting material, so as to avoid
congestions and colds. Besides proper protection to the chest,
there needs to be great care of the feet; they must not be
allowed to become damp and cold; silk or woolen hose are the
best. Frequent bathing in pretty warm water and rubbing
dry will keep the skin in good condition; and let me empha-
size this as important both as an eliminating process and for
purposes of equalizing the circulation and controlling the
febrile action. Some have advised the use of cold water,
thinking to prevent cold feet, and also to avoid susceptibility
of taking cold ; it may be used after the hot bath if only for
a moment and friction be at once applied to bring about
thorough reaction. There must be much caution or nervous
shock and congestions will follow, which will more than coun-
terbalance the good, but the foot-bath and a free use of the
bath about all the sweat-glands, such as are located in the ax-
illa and groin, with towel rubbing, are valuable adjuncts to
all kinds of treatment. The bath and protection by suitable
clothing, in no case must be overlooked ; non-conductors, such
as silks and wools being best next the skin. Application of
water at the temperature of 50° to the skin, especially about
the neck and chest, applied with the half- squeezed sponge, and
only for the moment, followed with free friction we think
tends to obviate colds. It can so be applied every day if care
is used. Reaction with a fine glow upon the skin is the test
of benefit and skill in applying the bath.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 141
Food. — Milk, sugar, cream, fats of different kinds and malt,
we have found beneficial in the management of our cases of
phthisis. The fattening properties of milk and sugar are very
well known. When we have found the stomach too weak to
digest milk or cream we have added a little choice brandy to
whip up its action.
We have for years been able to heal up a bone ulcer by giv-
ing the carbonate or phosphate of lime in our dilutions, put-
ting patients upon a spoonful of brandy added to half a pint
of milk, three times a day. The red corpuscles rapidly in-
crease and a cure is almost sure to follow. We have come to
attribute something of our success to the brandy and milk. If
chronic ulcers of the bone can be so rapidly repaired in this
way, why may we not hope to benefit our cases of phthisis in
a similar way.
Scrofula is usually behind both of these diseases.
The more cream the milk has the better, if the digestive
functions will appropriate it. Cream can often be taken when
no other kind of fatty foods can be tolerated ; cream and sugar,
to which may be added a little wine or brandy, or a few. drops
of muriatic acid, if better relished. Some have advised whey ;
it is a good carbon hydrate. We have given our patients
boiled fat pork, appetizing it with a little vinegar or lemon
juice, when they could take it. We have had patients who
really craved fat pork and would eat it with avidity. This
appetite has only shown itself after long fasting and inertia of
the stomach, and when energetic reaction was setting in.
Notably was the case of Miss T. of this class (reported under
Tuberculinum) after taking Tuberculinum.
We urge upon our patients also, to use malt as freely as the
stomach will tolerate, taking it with meals or just before.
Trommer's Extract has been our favorite brand. If patient
dislikes it, we recommend thinning it with a little beer or pale
ale, or better still with milk, if milk can be tolerated.
The fat of corned beef, or fat trimmed from a nice steak can
be often utilized. We think these fats not inferior to cod-
liver oil and they are usually more palatable.
Milk ranks first as a food, so far as our experience goes, in
142 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
all albuminoid diseases. We use it in albuminuria, finding it
almost indispensable. Milk and farinaceous foods, like rice,
oat-meal and the different preparations of wheat, are not as
likely to cause febrile excitement as meats. The patent-pro-
cess flour, possessing more of the phosphates and silicates, we
think the best of our brands of wheat, Graham flour as it
usually comes from the mills being too coarse. The outside
of the kernel could more largely be used with great advan-
tage if we could have it finely ground.
Sweet apples, strawberries, raspberries, blackberries and
peaches, may be freely used with farinaceous and fatty foods.
After all, many will decide to give cod-liver oil. A good
way to cover the taste is to add a few drops of Sulphuric ether,
and what is more important, it is thought to excite the action
of the pancreas upon which the digestion of fats so largely de-
In favor of the oil, statistics show that deaths from consump-
tion have fallen off some six per cent, since its introduction
C. B. Williams, of the Consumptive Hospital at Brompton,
London, in his'Lumleian Lectures observes that, "The expe-
rience of Louis and Laennec gave an average of two year's life
in phthisis after it was decidedly developed; but that since
cod-liver oil was introduced he infers from 7,000 cases, that
the average duration of life has been four years." Some will
raise the question if this improvement would not naturally
follow the dropping of heroic treatment. In other words, if
the disease, let alone to nature, would not give about the same
statistics of diminished mortality.
Whether oil is purely a nutrient or has minute quantities
of medicinal agents in solution, to add to its value as an arti-
cle for consumptives, has not been absolutely settled. It is
pretty certain, however, that it is a nutrient.
Dr. Williams says : " I have no hesitation in stating my con-
viction that this agent has done more for the consumptive
than all other means." Dr. W. has had in his charge many
There is a growing tendency to place fat at the bottom of
all molecular action in cell-growth.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 143
Dr. Chambers, speaking of cod-liver oil, remarks, that it is
"a typical aliment, representing what is the fittest of all
known substances to supply the deficiency that constitutes the
disease. Oleaginous substance is what is furnished by nature
for all primary growth, and nutrition of all the higher tissues
of all animal bodies; so that in administering it we are wisely
imitating the wisest teacher of medicine — mother Nature."
We may properly inquire at this point, what is the signifi-
cance of fatty degeneration found in connection with tubercu-
losis of the lungs?
Is it an imperfect effort of nature to repair herself from the
conversion of glucose into fat?
Doubting if we are able to prove exactly what Dr. Chalm-
bers says, or if we are fully competent from present data to
answer the questions raised, we may accept as pretty well
proven, that fat has something of an ameliorating influence
in a majority of cases of tubercular phthisis.
If cod-liver oil is used, we should be very careful to select a
good article; many now use the emulsion. The oil should be
condemned as unfit for use, if in the least rancid; dark-colored
oils are almost always impure; pale" or white oils are the only
ones to be accepted; these should be kept in a cool place, well
corked, and not exposed to the light; when taken, a few drops
of Sulphuric ether may be added. The best time to take it is
about half or three-fourths of an hour after meals; it will then
pass more quickly from the stomach, as the food will at that
time be moving downward. For myself I am not convinced
that cod-liver oil is better than other fats, which are more pal-
Cream has been successfully used in improving the flesh of
greatly emaciated children when emaciation has been caused
by defects of nutrition, and also from waste of protracted dis-
eases, and we have been using it for years with good results
for our consumptive patients in place of cod-liver oil, support-
ing it with other fats and malt. In some instances when we
have had patients suffering from feeble assimilative powers
and great debility, we have directed that they be well anointed
with oil twice a day, aiding by absorption through the skin to
144 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
keep up the motor energy of the system ; and more can be
done in this way than one thinks. The oil should be well
rubbed in, aided by heat.
The value of malt consists in having a large per cent, of
sugar and dextrine combined with fatty substances, a small
per cent, of albuminoids and phosphates, making it adapted
to weak digestion and the conditions of anaemia.
Much has been said lately about the carbon hydrates in
the management of consumptive cases, and as supplying both
motor energy and the constituents of blood globules, we con-
clude the opinion of the profession fairly sets that way.
The questions supposed to be settled as to the uses of carbon
foods and nitrogen foods is likely to undergo a revision. The
a iceptance of the doctrine of conservation of energy, requires
also the acceptance of the doctrine that force is transmitted
from one form into another, and that the forms of force bear
a fixed and quantitive relation to each other. From the car-
bons, we assimilate, come the chief manifestations of force in
muscle, gland, and nerve.
The functions of muscles, glands and nerves are largely to
distribute force obtained from these carbons, and in doing this
such force is often transmuted ; and so long as these carbons
are supplied but little waste is felt in any of these tissues.
Hence it is fair to conclude that such carbons are the feeders
of these tissues, and that starvation will follow if they are
withheld. It appears also that whatever carbonaceous food is
not wanted for present use, is stored within the body, and
chiefly in the form of fat. A trifle of this, it is true, is pro-
duced from the splitting of albuminous matter, which under-
goes transformation. Failure of ability to dissolve amylaceous
foods, and transmute them into fat cells, is one trouble with
consumptives, making necessary the use of fats in increased
quantities. Emulsifying these fats, aids in their absorption.
It is worthy of note that several remedies known to act
upon the liver and internal glandular system have the symp-
toms of aversion to sugar or fats. Arsenicum has aversion to
butter, but desire for milk and lard. Calcarea carb. has aver-
sion to meat and nausea after milk. Calcarea phos. has colic
PHTHISIS PULMONALIS: TUBEKCULAR PHTHISIS. 145
from eating ice-cream. Causticum has aversion to sweet things.
Ferrum has aversion to meat, which disagrees; after fat food
bitter eructations. Hepar s. c. has aversion to fat. Lycopo-
dium, desire for sweets; constant sense of fermentation; con-
stant sense of satiety. Mercurius, aversion to greasy food ; de-
sire for sweets, but they disagree. Natrum sulphuricum, fari-
naceous food causes diarrhoea. Nitric acid has longing for fats,
but fat food causes nausea and acidity; milk disagrees. Phos-
phorus, aversion to meat and sweet things; wants ice-cream.
Pulsatilla, aversion to fat food and to milk. Sanguinaria, sugar
tastes bitter; sweet things aggravate and cause burning. Sepia,
diarrhoea after drinking milk; particular aversion to meat.
Sulphur, aversion to meat, milk disagrees; desire for sweet
things; a good remedy when sugar disagrees. Thuja, oily or
greasy substance in stool. Zincum, aversion to sweet things
and to meat. These are the remedies which have gained the
foremost place in our clinical reports upon phthisis. The
symptoms we have given indicate the use of the remedies for
troubles where fat is not assimilated, and where sugar is not
readily transmuted into fat. The subject as brought forward
here is tentative and will bear further study. The function
of the pancreas being that of emulsifying fats and preparing
them for assimilation, it would be well to ascertain what reme-
dies have a special action upon this gland. Recent investiga-
tions seem to prove that Sulphuric ether and Sulphur are fore-
most among these. The function of the liver being largely
that of converting sugar and starch into fats, it is well to study
the importance of keeping this organ in a healthy condition.
I need not mention particularly other organs connected with
Climate. — The importance of fresh air, combined with regu-
lar exercise out of doors, is of great importance in improving
the circulation and assisting in the elimination of morbid pro-
ducts. The muscles are strengthened, the heart's action is
more vigorous, and the nervous system is toned up.
To facilitate this a choice of climate is of very considerable
Elevated climatic stations where there will be snow for
146 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
several months in the year, have the advantage of supplying
an atmosphere free of dust and also a thinner air. Torpid
constitutions and those troubled with a slow digestion, are
often benefited by such an atmosphere; but persons who suffer
from stimulation, have quick pulse, redness of face and dysp-
noea, should not go to such a climate; nor should blood-spit-
ting patients, nor those troubled with laryngeal affections.
Persons who go to Colorado and other high altitudes, are apt
to delay their visit too long. They should go in the earliest
stage of the disease in order to be benefited. A warm, moist
climate, such as we find in Alabama, Florida, and the small
islands of the tropics, agrees with a larger number of consump-
tives, though such a climate is too relaxing for some. If one
has a bad digestion and is subject to diarrhoeas, he is not likely
to be benefited. By going inland upon plateaus with higher
elevation, possibly such may be able to get something of the
equability of the climate, and escape enteric and stomachic
The city of Mobile and its surroundings offers as favorable
advantages as any we know of in this regard. The atmosphere
is free from malaria, the soil is sandy, and at no great distance
away are to be found elevated plateaus which carry one beyond _
the fog and dampness, if this become too depressing. The
mean temperature is very favorable for avoiding pneumonic
congestions and inflammations, and such complications are
usually those the patient and physician most fear. Only twice
in the years between 1869 and 1880 did the thermometer regis-
ter on any day in the months of December, January and Feb-
ruary as low as 20°, and that only in the night. The extremes
were from 80° to 20°. In the majority of the years the mer-
cury only ran down to 28°. March and April are always
pleasant months in this vicinity., This enables the patient to
spend much of his time in the open air.
Six miles from the city there is elevated ground, pure water,
beautiful scenery with balmy breezes blowing from the gulf,
all favorable to the repair of diseased lungs. If the air is ever
too damp here, the cars will carry one in two hours to the pine
hills, wholly beyond any depressing influence of this kind.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 147
Such being the topography of the country, one may spend
most of his time in the city, sure of a safe retreat near at
hand, if at any time he has need.
As a rule we ought never to send our patients away from
home when the febrile symptoms are active and all indications
show the disease making steady progress. Patients are often
sent away who should be in bed half of the time, receiving
treatment to allay actively progressing movements of the dis-
ease, and when better, may be sent away if thought best ; but
sending people away from home to die, is not complimentary
to the physician, while to the patient it is a cruelty.
The remarkable cures reported from persons camping out in
the Adirondack region within the past two years, only proves
the importance of securing good air, and exercising in it. A
better elimination of effete products is thereby obtained, and
consequently a better digestion. This can be secured in almost
any dry northern woodland with variegated scenery, by se-
lecting a sheltering crag.
Camping out in the Alabama woods would be less rigorous
in winter, and prove to a majority, we think, a better success.
Acclimation, however, is a great point, and hardening where it
can be accomplished is a part of the cure. TJie air, the air
should be the first part of the prescription to every consump-
tive patient; and to secure its entrance into all the air-cells,
we should order the use of the respirator or other pneumatic
apparatus in a systematic manner.
In all tables of statistics yet published where the mortality
of phthisis has been the subject, there has been an invariable
increase of fatality, and numbers where the habits have been
sedentary and of in-door life. No matter what the climate,
out-of-door life is beyond dispute beneficial to persons with
pulmonary tendencies. Agricultural pursuits are much to be
preferred to work behind the counter or in a dusty shop. A
quiet, easy life, as the country gentleman might follow, would,
to our mind, be representative in character. Riding, hunting
and fishing, and other sports followed out-of-doors, give the
proper stimulus to the muscles, quicken the digestion, and
help to thorough breathing. If the lungs are broken down,
148 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
then exercise will have to be passive, such as one gets from
riding in an open carriage, being rowed in a boat, or from
swinging in a hammock.
One may lie for hours basking in the sun and fanned by the
cool air, to advantage. Sun-baths and air are not only enjoy-
able, but indispensable. We must remember the skin has a
wonderful eliminating power. "The poison of a rabid dog,
a snake bite, and other infectious poisons," says an eastern
physician, "may be wholly eliminated from the system by
baths at 130° to 150° Fahrenheit; and vaccine matter does not
take if excessive perspiration follow soon after the inoculation."
The value of thorough breathing and exhalation from the
skin cannot be overestimated.
Summing up what may be said of climate: a sunny, dry,
cool and stimulating climate is undoubtedly the best, not too
cold nor too hot, nor is a high altitude to be chosen except for
sluggish natures needing a constant stimulus. Northern New
York, the shores of Lake Michigan or Colorado in summer,
Santa Barbara, Alabama or Florida in winter, for such as are
able to bear the expenses of a migratory life, would seem to
meet the climatic requirements, as well as may be done in the
Western continent. I have been persuaded that the equability
of temperature along the eastern shores of Lake Michigan
offers some advantages to the consumptive invalid, but the
locality has the objection of being malarious till you reach the
upper portions of the lower peninsula.
The western shore from Chicago to Milwaukee has a dryer
atmosphere, a sandy soil free from malaria, and statistical
health tables place the locality in the front rank for sanitary
resort. A sanitarium for consumptives at Waukegan on the
west side, and at Petosky on the east side of Lake Michigan
would be well located. Minnesota and northern Wisconsin
are favorable localities.
Hot Baths. — There is no doubt that free exhalation carries
from the system large quantities of poisonous and effete matter.
Under the action of a bath at 90° to 100° Fahrenheit, the
rheumatic morbific agent is expelled. Some have gone so far
as to report the elimination of the virus of rabid animals by a
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 149
bath of 135° to 145° after spasms had actually set in. We
know that nature sets up the sweating process to remove dead
matter from the body. What is the significance of the drench-
ing sweat of the consumptive? I do not suppose that we are
to drift tubercle from its lodgment in the lungs by baths at
any temperature, but when nature declares her efforts at elim-
ination by the sweating process, it is well to inquire if we may
not act upon the hint. Sun-baths are found to be good and to
protract life, but I do not know that water-baths of a high
temperature have as yet been tried. It is our opinion that
they can be made adjuncts to well chosen medication. Drain-
age of effete and tuberculous matter, either by an opening
through the walls, or the emunctories will tend to obviate the
very general evil of auto-infection.
Surgical Drainage.-The subject of making openings through
the thoracic walls, has been recently discussed on both sides
the Atlantic, and tried in a few cases. Professor Mosler, of
Griefswald, read a paper before the Society of Naturalists and
Physicians, assembled at Wiesbaden on September 23d, 1873,
in which he presented the plan of opening into pulmonary
cavities and inserting drainage tubes. This plan also inclu-
ded appropriate topical treatment by access to the walls of the
cavity through the opening.
Professor William Pepper, of Philadelphia, was engaged upon
investigations of a similar character about the same time.
In the Philadelphia Medical Times for March 14th, 1874,
Prof. Pepper published a paper " On the Local Treatment of
Pulmonary Cavities by Injections through the Chest Wall."
The American Journal of the Medical Sciences for October, 1881,
has a paper upon " Opening and Drainage of Cavities in the
Lungs," from Drs. Fenger and Hollister, of Chicago, suggestive
in its character.
That abscesses may exist in the lungs and recovery take
place has been conclusively proved. That cavities may be
safely opened into is well agreed upon. If they arise from tu-
bercular deposit it is not agreed whether anything can be
gained by drainage through the external walls. Our own ex-
perience only extends to opening into a cavity of a scrofulous
150 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
nature when there was a slight prominence between the ribs.
It was in the case of a young man whose mother died of phthi-
sis. The cavity partook of the nature of an abscess, and puru-
lent matter was expectorated freely, while from the opening
large quantities of purulent matter continued to flow for sev-
eral weeks. The case was saved no doubt because of the su-
perficial character of the abscess.
A good recovery followed, but the chest walls were some-
what contracted. Echinococcus cysts of the lungs are success-
fully treated by drainage through the walls, as well as empy-
ema. But it has generally been thought that the lung must
be so extensively involved in the tuberculous degradation be-
fore pus cavities form, and the vital powers so far prostrated
that the operation is not warranted save in very exceptional
cases, when the lesion is superficially situated, with adhesions
of the pleura to the chest walls.
•Deep lesions do not always prevent recovery, unless fatal
hemorrhage follows. But the more central the wound the
more doubtful the recovery of any important lesion. It is
plain the abscess must be clearly located before any attempt
of this nature can be made ; and if adhesion to the walls exists
there is much more likelihood of success.
We are prepared to see sentiment setting in favor of this
Pneumatic Treatment. — The spirometer has gained some
attention recently from the profession in the management of
phthisis pulmonalis. There is no doubt that the free use of
the instrument tends to keep the air-cells open, and may in
the earlier stages of phthisis do much to prevent the occupancy
of the apices with tuberculous matter. After the deposit has
occurred there is less to be expected from its use.
The modification of the Hutchinson spirometer by Prof.
Waldenberg, of St. Petersburg, Russia, can be used in a man-
ner to increase the power of both inspiration and expiration,
and is the best instrument we have.
Certain arm and shoulder movements facilitate the expan-
sive capacity of the lungs, and may be practiced somewhat
upon the principles of the Swedish movement cure, always
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 151
taking great care not to prolong exercise beyond healthy re-
We prefer Niemeyer's classification upon this variety of
phthisis, and would not confound the disease with rapid de-
generation and softening of the caseous exudation, which some-
times occurs in connection with pneumonia and is often termed
"galloping consumption." In a large per cent, of acute cases
of phthisis, however, the disease occurs where the lungs have
old caseous deposits. From this fact the question has natur-
ally arisen, whether this acute phthisis does not come of some
pernicious effect which the cheesy deposit exercises upon the
blood ; but it is not confined to this class of crippled constitu-
tions wholly, and must arise also from other and unknown
causes. The tubercular deposit is always of the miliary kind,
and nearly always exists in a state of crudity. The lungs will
be found studded from apex to base with these millet-seed
sized granules ; often the pleura and other organs also becom-
ing involved. As the lungs may be studded with these gran-
ules without producing any perceptible dulness, the diagnosis
is not always easy to make out. It may be confounded with
pneumonitis, pleuritis, capillary bronchitis, typhus fever, in-
termittent or typhoid fevers, as w T ell as certain diseases of the
heart. There are, however, differential points usually, which,
if carefully studied, will enable one to come to pretty definite
conclusions. The dyspnoea, the high grade of temperature and
rapid pulse, are important ; the family history and diathesis
are also very important. The prognosis is unfavorable; never-
theless the prompt administration of the true homoeopathic
remedy should be tried. We may possibly see better results
than expected. The Apium virus, I believe the best remedy
we have. In Ferrum, Calcarea phosphorica, Iodine, Phos-
phorus, Sulphur, Zincum, may sometimes be found a better
152 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
similimum, and if so no one will hesitate about giving them
a trial. Most writers speak of the disease as beyond the reach
of all medication. We do not think the homoeopath is to look
upon any disease in its inception as outside the limits of pos-
sible relief. Upon the theory that in acute miliary tuberculo-
sis we have an acute lymphangitis, we put forward in part
Apium virus as a probable remedy. The frequency of respi-
rations as well as the pulse, when compared with the grade of
fever, seems to have some analogy of symptoms. Raue brings
forward Arsenicum, Gelsemium and Lachesis, in addition to
those mentioned ; and in the advanced stage Ammonium carb.
is suggested, but no indications are given.
Drs. Wood and Formad, in making experiments upon rab-
bits by inoculating them with the membranous exudation of
diphtheria, found that tubercular deposit followed. What the
significance of this fact may be we are hardly prepared to say.
The two diseases seem to be of the class presenting the condi-
tion of hyperfibrinosis. It looks a little as if there were an
element of propagation here, that fibroid degeneration passed
over into tubercle, and that the lungs were the seat of the
morbid product in the rabbit. If it should be determined
that acute tuberculosis is essentially an active and possibly in-
fective lymphangitis, it would support by analogy and on theo-
retical grounds the indications of Apium virus.
CHRONIC TUBERCULAR PHTHISIS.
By this term we mean those cases of consumption which run
their course in the ordinary way : first, in deposit of caseous
exudation or by tubercular infiltration ; second, in the soften-
ing of tubercle and the breaking down of both tubercle and
the surrounding tissues ; third, in resolution and recovery by
expectoration, with cicatrization of the walls of cavities, and
possibly by crystallization and encysting of tubercle, or death
from exhaustion and the poisonous influence of purulent mat-
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 153
ter in the circulation. These cases may come to us from all
the sources discussed in previous chapters and possibly from
still other sources.
We have at this juncture albuminous matter either in the
air-cells and mucous membrane, or in the walls outside of the
vascular vessels, or both, undergoing the cheesy or fatty trans-
formation, probably with tendencies also to the production of
earthy phosphates. Often the surrounding structure becomes
inflamed and the inflammatory action in the parenchymatous
structure, is going on as a limited pneumonia where fresh tu-
bercle may be depositing.
The apex of the lung is usually the point first attacked and
will be more completely and heavily loaded down with tuber-
cle, though frequently considerable extension of the disease to
other parts of the lung will be found, and cases are not want-
ing in which a greater portion of both lungs has been loaded
with this exudation.
As one lung is primarily affected, and as there are primary
seats of exudation in the same lung, we will find often all
stages of advance in the same person, perhaps in the same
lung. It is no more nor less than an ulcerative process with
the purulent matters burrowing in the lungs. At this stage
the bronchi often become loaded down with purulent matter
from their terminal ends by coughing, and the case may be
complicated by auto-infection. The cavities may be isolated
or their may be several communicating with one another.
They vary much in size, from that of a hazel-nut, or even
smaller, to cavities occupying large portions of the lung.
Recent cavities are irregular, with rough and jagged walls;
later the fibrous tissue is fully dissected out, leaving only the
more indestructible parts, such as blood-vessels, bronchi and in-
durated fibrous tissue ; very old cavities are usually lined with
a smooth membrane. The contents of cavities may be quite
different, showing the changes purulent matter undergoes from
the influence of air and the progress of chemical degradation.
Associated with these cavities we not only have tubercle in
advancing stages in other portions of the lung, but possibly
154 PHTHISIS PULMONALISI TUBERCULAR PHTHISIS.
we may find portions of the lung where the disease is retro-
We may also have pleuritis, and the adhesions may be very
thick and firm; we may have pneumonitis, bronchitis and
emphysema, even collapse of the lung, subjects which have
been fully discussed in previous chapters.
Errors and Inadequacy of Phthisical Therapeutics. — It
is astonishing to witness the mental obtuseness which follows
a training in dogmatic systems of thinking. One would think
that so great a vitalist as Dr. James Henry Bennett would
never be guilty of comparing therapeutical action to manuring
a field, but here are the doctor's own words: "In phthisis
observation shows that it is judicious to increase the usual
amount of fat given into the system, and observation seems to
show that it is equally right to increase the amount of phos-
phates. Phosphorus is only contained in limited amount in
our food, although it exists in so large a proportion in our
system; its administration in a disease of debility may there-
fore be compared to manuring an exhausted field. If corn is
grown in succession in the same soil the crop at last fails for
want of phosphate of lime, which is necessary to form the
grain. It is in this sense that I give the preparations of phos-
phorus." Could there be a statement more utterly short of
indicating true therapeutical action? If the vital powers have
so far succumbed as to be unable to appropriate the organic
phosphates found in food, what shall we say of a man's intel-
lect which conceives that the crude mineral phosphates can
be shoveled into his patient's stomach to advantage? Phos-
phorus indeed may be a therapeutic agent, but only by virtue
of the power it has to provoke the vital forces into movements
which shall enable transmutation to go forward among mole-
cules which can thus be made to build and repair structure;
only by substituting a healthy vital action for a morbid ac-
tion; only by arresting the progress of retrograde metamor-
phosis, or degrading chemical action can forward vital move-
ments take place. Thus the defective elements in old school
therapeutical management of phthisis is shown upon the very
threshold of the discussion. This Dr. Bennett who has written
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 155
a work on consumption and offers his own case as a specimen
which he claims to be exceptionally well managed, says : " I
have avoided as much as possible the circumstantial enumera-
tion of local symptoms, which are much the same in all cases,
as also the details of treatment. Each case is intended to il-
lustrate a pathological type or a social phase of pulmonary
consumption." Now, most likely just that circumstantial enu-
meration of symptoms must tell us the remedy adapted to the
case; as each case must be thoroughly individualized in its
symptomatology, which expresses the sensorial and most im-
portant side, to add to the pathological side, to meet the de-
mands of homoeopathy, we see how much more completely
homoeopathy grasps the subject. As every case is individual,
so we need to know in what that individuality consists and
find its correspondence in therapeutical agents. So eminent a
physician as Prof. Austin Flint has little to offer but hygienic
treatment, such as consists in change of occupation and good
air. It is to be hoped that we are entering upon a new era in
the treatment of this terribly fatal disease.
Lungs and Thorax. — Soreness in the upper part of the
chest ; pains are usually in the left thoracic region and opposite
the middle of the sternum (this suggests sympathy with the
Cough. — Cough provoked by constrictive feeling in the throat
and by pressure at the sternum. Irritation to cough in the
supra-sternal fossa. Cough dry, with gagging; with painful
concussion of the head. Little or no expectoration.
Aggravations. — After sleeping (Lach.), by lying on left side
(Lye, Phos.) ; by recumbent posture.
Accompaniments. — Among the throat symptoms we have
hoarseness and congestions of the mucous membranes; speak-
ing is painful ; feels as if wearied in the larynx. The breathing
156 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
is hurried and difficult, worse from motion, worse in a warm
room. Patients have a pale, sickly look ; pale and sallow ;
burning cheeks with cold feet; red face, hot and swollen;
oedema about the eyes (Kali c.) ; swollen lips ; and lymph glands,
small and great, inclined to tumefaction.
Pulse is accelerated ; may be strong, or may be weak ; inter-
mittent, or wiry and frequent; conditions pointing to an in-
flammatory action of the vessels. Nervous symptoms are
trembling, great prostration, tired feeling, restlessness.
Tuberculous patients are always wishing that they could get
The action of Apium virus on the system frequently pro-
duces a craving for milk, which relieves.
The power which Apium has to control glandular enlarge-
ments and irritations goes to support its claim as a remedy in
tuberculosis of the lungs ; and we bring it forward confidently
expecting that it will take high rank among our remedial
agents in the early stage of tubercular affections of the chest
organs, as it already has in albuminous exudations in other
That there may be something in this constitutional albumi-
noid diathesis we quote Dr. Henry Bennett in proof. " Most .
winters at Mentone, I lose one or more of my consumptive pa-
tients from Bright's disease." He further says, when in Paris
he found many of his old associates believing in the curability
of phthisis, but one and all stated, that many of these cases of
arrested consumption had subsequently died of some other
form of cachectic disease, and principally of albuminuria. For
the cure of albuminuria we regard Apium the most important
remedy we have.
For that form of phthisis which declares itself in a general
lymphangitis especially do we bring forward Apium virus.
In acute affections of the glands and lymphatics, if we may
judge by its provings, it must become a leading remedy.
Lungs and Thorax. — The chest symptoms are usually more
pronounced upon the right side. We have sharp pains in upper
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 157
third of right lung. Burning in the chest ; feeling of rawness
and soreness. Constriction of the chest. Dr. Gregg offers the
symptom, "burning in the upper portion of the right lung, with
Cough. — Cough dry and fatiguing. Paroxysmal, violent.
Sometimes with glairy, frothy, transparent sputum, which
later in the disease becomes yellow or grayish-yellow.
Aggravations. — In the morning on rising, or in the evening on
lying down (Phos.). After drinking. On going into cold open air.
Worse about midnight.
Accompaniments. — Face has the bloodless cachexia, well
stamped, as seen in the waxy, gray, pale, earthy and bluish
tinges of the skin; the face is also swollen and sometimes
flushed; but the former is a rare symptom in tuberculosis, un-
less in connection with fatty degeneration.
There is much disturbance of the stomach, pains in the re-
gion of the liver, and engorgement of the spleen ; tenderness
with burning sensations are quite typical of Arsenicum.
In the febrile activity we have much shuddering, worse in the
open air, with little thirst, or if thirst, it is short, calling for only
a little fluid.
The chill is often undeveloped, being more internal, often alter-
nating with flushes of heat ; sometimes chilliness comes several times
a day, seeming to be of a nervous character, as little heat
Hurried breathing upon moderate exercise, dyspnoea on lying
down are accompanying symptoms in tuberculosis. Voice is
weak and trembling; feeling of oppression increased by heavy
air and stormy weather. For tissue waste with great weakness,
and disinclination to muscular movements, Arsenicum has a
Like Apium it has a very decided action upon the lympha-
tics, and in plastic exudations is used to awaken absorbent
Its influence is seen upon the nervous centres, especially of
the organic or vegetative system, upon the blood corpuscles
and the glands. It seems to increase the power of the system
in the production of fat, thus being able to correct certain faults
158 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
of assimilation. Whether this has anything to do with the
service it renders in consumptive cases, we are unable to say ;
certain it is, that it is an active agent when used to unload the
glands, and when wanted to work an excess of fluids from the
system. It is an anti-hydrogenoid.
We will report three or four cases of unequivocal character,
where Arsenicum has proved of service, but would advise that
it be tried early in the disease and before the tubercular deposit,
as a means to prevent exudation.
Clinical. — Case 1. — "Mrs. W., set. 32, of a nervo-bilious tem-
perament, with dark hair and dark eyes, quite slender, had
passed two menstrual periods. Was harassed with an irritative
cough, and had been for some months; dulness of right lung in
the apex; had hectic fever. The symptom to which we attached
most importance in selecting a remedy was shuddering without
thirst, or full development of the chill. This occurred two or
three times in the twenty-four hours, and was worse when in the
open air; her expectoration was but slightly purulent, mostly
of a frothy mucus, though portions were yellow and thick ;
had night sweats of a cold clammy nature. Gave Arsenicum 200
with so favorable results that chills were at once arrested and
resolution was so rapid that she menstruated in eight weeks ;
became pregnant and miscarried at the third month; flooding
was serious, and went into a rapid decline, dying of phthisis
within ten weeks after miscarriage. Her pregnancy shows the
extent of curative reaction made by the Arsenicum, and her
death the correctness of the diagnosis."
Case 2. — " Louis Emmel, set. 34, weighs 120 pounds; a Ger-
man, pale, hollow-cheeked, blue eyes; a cigar-maker; has been
in this country two years; ailing ever since; is now so weak
that he can hardly walk to my office ; coughs, particularly after
midnight until morning; usually gets no sleep after one o'clock;
after having coughed a while a disgusting taste of the yellowish-
green expectoration which is quite profuse; aching, distressing
pain in the upper right lung ; the pain is worse when coughing ;
while coughing extreme thirst for cold drinks, particularly cold
milk, wishing to drink very often, but not much at a time; per-
spires profusely after midnight; no appetite; soreness in the
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 159
region of the stomach after eating, and sensitive to extreme
pressure; bowels at times loose, and then at other times cos-
tive. Four weeks ago raised several mouthfuls of blood ; half
of the upper right lung dull on percussion; respiratory murmur
very trifling in lower part of the lung; gurgling, rattling
sound under right clavicle as if from a cavity; left lung nor-
mal ; pulse over 100. Arsenicum 1 " 1 , Fincke, one dose. Five
days later reports great improvement; can sleep until 3 or 4
o'clock; much less thirst and some appetite; perspires very
little ; improved steadily until the 4th of October or about a
month, when he drank three glasses of beer, after which raised
sputa streaked with blood ; on this day he got Arsenicum 38111 ,
Fincke, one dose. Oct. 25, reports expectoration diminished
one-half; no perspiration; sleeps until 5 or 6 o'clock; expecto-
ration nearly colorless, and has no taste; no pain in the right
lung; weight increased in a short time to 134 pounds; dulness
less, and far less rattling in the region of the cavity under the
right clavicle; his general improvement is so marked that
there is good reason to believe the lung will gradually mend."
— Wm. P. Wesselhceft.
Case 3. — "H. T., set. 28, tall and slender, elongated and nar-
row chest, subject to sexual excesses, has had a hacking, dry
cough for several years. In 1870 had an attack of pneumonitis
of which he was thought to be cured, but was left with a hollow-
sounding cough, dyspnoea and stitching pain in the chest, fol-
lowed in a few weeks by a severe hemoptysis. The bleeding was
troublesome for a week or so ; the cough continued growing
more and more severe, attended with hectic fever and much
prostration. Aggravation at night, but coughed both night and
day ; night sweats ; pale face with red spots on both cheeks ;
dryness of throat and mouth; ravenous hunger; tormenting
thirst ; red urine which scalded at micturition ; sometimes long
retention of urine ; much restlessness day and night ; burning
in the chest, and shooting pains ; expectoration of fetid, dark,
greenish solid lumps of matter. Arsenicum album, 3d, 6th
and 12th trit. cured the case." — Dr. Arndt.
Case 4. — "A girl, set. 24, of graceful form, was taken with rais-
ing of blood in the summer of 1857, with well-defined symptoms
160 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
of tuberculosis, which increased so much by the spring of 1858,
that the patient was confined to her bed and seemed at death's
door. She is very much emaciated ; coughs a great deal ; the
sputum is chunky, yellowish-brown and of disagreeable sweetish
odor; the left lobe of the lung as far up as the middle of the
scapula is studded with tubercles ; pulse rapid and small ;
diarrhoea; has not menstruated for four months. Arsenicum
restored her to full comfort, brought on a return of menses
and enabled her to discharge the duties of life." — Eidherr in
Neue Zeitschrift, IV, 190.
Dr. N. V. Miller uses Ars. iod. for following symptoms:
"Soreness in larynx; hoarse, racking cough day and night,
with profuse purulent expectoration."
Lungs and Thorax. — There is a feeling of tightness upon
the lungs ; hardly able to get a full breath. Right lung more
pointedly impressed, often sore.
Cough. — Comes from tickling in the throat; frequently from
elongation of the uvula.
Aggravations. — On waking at 3 a.m. (Kali c), 11 a.m.
Accompaniments. — One awakes with difficulty of breath-
ing ; has to have the windows open and get the face to fresh
air (Carbo. veg.). We have hoarseness and aphonia ; increased
secretion of the bronchial tubes and fauces.
Dr. C. C. Smith gives as a key-note for its use for tubercu-
lous patients, "chill every morning at 11 o'clock, and fever
each afternoon." Additional symptoms are : chilly over the
back while sitting at the fire; feet cold with other extremities hot;
awakes at 3 A.M., with flushes of heat as if perspiration would start.
Dr. J. S. Mitchell recommends it for: "Chill in the forenoon
or afternoon, followed by heat and perspiration as in ague : general
weakness and languor ; sometimes loss of hopefulness." Bap-
tisia is adapted to many symptoms which find expression in
the tubular passages, and may be used to ameliorate some
cases of phthisis, but hardly meets any cachexia.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 161
Lungs and Thorax. — Sore pains in the lungs felt more by
deep inspirations, and stitches when moving. Stitches in both sides
of chest aggravated by leaning forward. Sharp, slow stitches in
left side of chest, in a line horizontal with the pit of the stomach.
Stitches in the chest from the left to the right side with sense of
Stitches mostly begin on left side.
Sharp stitches in right thorax, from within ontward, not affected
by breathing as most Calcarea pains are.
Cough. — The cough is dry, especially at night, often violent,
and when expectoration follows, the feeling is as if something
had been torn loose, Cough is provoked by air carried down by
full inspirations ; and by tickling in the throat as from feather-
down ; also by eating, and playing on the piano.
Aggravations. — Morning and evening.
Accompaniments. — Morning exhaustion; dozing even after
getting upon the feet. Intense melancholy. Very forgetful. If
patient be a woman still menstruating, menses too early, too
profuse, too long lasting.
Face chalky colored, pale, may be bloated or may be thin;
if thin skin inclines to shrivel.
Flesh often flabby and soft. Lips swollen. Eyes surrounded
with blue rings.
Neck is slender and head seems too heavy for the small size
of the muscles.
Derangements of the stomach, such as a sense of weight soon
after eating; pressure at the pit, which is distended, eructations
which are tasteless or sour ; spitting up of food or vomiting of in-
gesta; rapid loss of flesh (Iodine). Abdomen bloated; mesen-
teric glands swollen, and various peculiarities in the excreta;
such as, hard at first, then thin, offensive and clay-like or chalky
stools, with inclination to prolapsus recti.
We have painless morning hoarseness; aphonia, desire for
deep inspirations and shortness of breath with vertigo, especi-
ally when ascending stairs or going up hill. Stitches in left
mamma when coughing. Stitches in Calc. carb. about as
162 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
marked as in Kali carb. Dr. Gregg gives : " Pain in the
upper half of right lung (Ars.). Cough with purulent sputa*
worse in the morning on rising, and in the early evening, with
paroxysms during the day, less during the night. Loud breath-
ing through the nose, bleeding from right nostril."
Dr. Fellger gives us the symptom: "Expectoration falls to
the bottom in water, with a trail of tough mucus behind like a fall-
Dr. C. C. Smith: "Whole chest intensely painful to touch."
Calcarea is a very important remedy in arresting tubercular
deposits and in keeping them latent after being deposited. It
is well adapted to disorders connected with faults of secondary
assimilation. With such defects there exists a tendency to
hypertrophy of the lymphatic glands, and obstructions in the
lymphatic vessels. It is often of more importance to correct a
constitutional tendency than to exert one's self to overcome a
difficulty which has asserted its full force. Our efforts in the
one case may be entirely successful, whereas, in the other we
make little headway. It is the constitutional tendency which
should always be attended to in these cases, and Calcarea is
among our most important constitutional remedies.
Clinical. — Case 1. — Mary Foster, set. 4, with blue eyes, large
head, and small muscles, does not seem to grow well ; eats little
and is very nervous. Tires out easily. Upper lip a little swollen,
teeth very white. Inclined to diarrhoea, undigested food passing
with the excreta. Tendency to curvature of the spine. To look
at her seems as if her neck were too small to carry so much head.
Flat chest and wing-like shoulders. Gave Calcarea 6th attenua-
tion with a quick response, and advance of nutritive move-
ments which resulted in firm health and in giving general har-
mony to the structural development in the course of two years.
— G. N. B.
Case 2. — Frank W., a lad set. 10, blue eyes, light, thin hair,
pale, thin face and of a scrofulous disposition. One year pre-
vious to my call a periostitis set up in the shaft of the left
tibia upon the inner side. Case as presented to me the first
time : bone has exfoliated along the whole length of the shaft ;
ulcer is so deep that not more than one-half of the supporting
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 163
structure remains and leg is much bent; ulcer keeps up a con-
tinuous discharge which has left little vital resource behind.
Patient is not only badly emaciated, but has a hectic fever and a
bad cough with dulness in the right apex. Cough is dry and
harasses him in the evening; has night sweats. Was given
Calcarea carbonica 6 , and urged to use milk freely as a diet,
to which was added the amount of three tablespoonfuls of
brandy every twenty-four hours. Ulcers were fully healed
and bone reparation complete within the next twelve months.
All traces of lung trouble also passed away and I have never
known of subsequent trouble, though case passed from my ob-
servation in the course of half a dozen years. We will here
add that we have many times succeeded in curing these bone
ulcers, commonly called "fever sores," with the use of Calcarea
carbonica, milk and brandy, and they all remain cured so far
as we know. — G. N. B.
Case 3. — J. Hall, set. about 14, of a scrofulous lymphatic tem-
perament ; mother died of tubercular phthisis four years after
case reported convalesced. When consulted found patient with
a bad cough and rapid respirations, accompanied with an irri-
tative fever. Percussion showed extensive dnlness through apex
of left lung and down to fourth rib; fever increased notwith-
standing remedies and soon assumed the hectic character. A
large cavity, really an abscess, formed, and fortunately was
sufficiently anterior and near enough to the surface of the
lung to point at the left nipple where it was opened. The
abscess communicated with the large bronchus also, as puru-
lent matters were expectorated through the broncho-tracheal
passages. It seemed a gallon or more of purulent matter
passed away in the next six months through opening at the
nipple ; purulent expectoration continuing also at the same
time from the mouth. Patient took Calcarea carbonica and
was well fed, and given a little brandy and milk four or five
times a day and made a recovery in the course of the year.
Cure attributable not a little, probably, to good drainage. — G.
Case 4. — Mr. K., a young man, set. about 21, family decidedly
consumptive ; slender built, of a waxy, pale complexion, auburn
164 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
hair and blue eyes. Troubled with a severe cough of a dry
character, worse at night; sometimes stitches in the chest and
inclined to diarrhoea of a liquid nature and mixed with indiges-
tible substances ; bowels a little prominent and tender. Diag-
nosis : tubercle in mesenteric glands and parenchyma of the
lungs. Gave Calcarea carbonica 30 . General improvement com-
menced and continued for some time ; patient continued his
work, which was that of a train express man ; gained flesh and
strength, though the cough did not altogether disappear; took
a fresh cold, quit work and very soon active hectic symptoms
set in and patient went to another part of the State to die
among friends. The value of the case is in showing that for a
season advance of tuberculosis and degradation of tubercle
were arrested by Calcarea. Termination of the case showed
tubercular affection of both the mesenteric glands and the
lungs. Whether under better management case could have
been pushed to complete curative results is the question to
raise. We would now give higher potencies of Calcarea car-
bonica for a similar case and try to obviate aggravations from
catarrhal attacks. The value of Calcarea in scrofulous swell-
ings is fully admitted and suggests its value in tuberculosis.
In faulty assimilation and chronic diarrhoea as well as in col-
liquative sweats, it covers many symptoms that accompany
pulmonary tuberculosis and tuberculosis of the mesenteric
glands. In glandular enlargements, scrofulous ulcers and the
gravest forms of catarrhs, we have accomplished all we could
ask.— G. N. B.
Case 5. — Mrs. B. of a scrofulous constitution through paternal
side; of sanguine nervous temperament, auburn hair and dark
eyes. Grandmother, father and two sisters had goitre; one
sister died of tubercular phthisis of the lungs, showing no sign
of goitre, nor did the present subject; grandmother always
troubled with a cough, though she lived to old age ; consump-
tion still more common in other branches of father's family ;
patient had whooping-cough when a child from which she
recovered with difficulty and was always subject to a harassing
cough of a dry provoking character; after her marriage was
somewhat better, but after bearing her second child she showed
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 165
evident signs of decline, losing strength and flesh for six weeks
with cough, growing steadily worse. At this time she took
Arsenicum 30 , being led to it by peculiar numb sensations in
the upper extremities, soreness and pain in apex of right lung,
the cough being worse immediately after lying down, accom-
panied with titillation in the larynx. She soon improved and
got on very well till the next spring, when she was taken down
again ; this time she was tried on her old remedy, but to no
purpose, but Calcarea 30 did arrest the cough and other symp-
toms which were as will be seen more conformable to its path-
Cough was very dry and harassing morning and evening, espe-
cially with tickling as from feather-dust in the throat ; if any
sputum was thrown off it seemed as if it had to be torn from
the larynx ; tongue would often protrude from the mouth so violent
was the cough, and with such difficulty was anything detached.
Calcarea carb. had the effect to finally control the worst of
these symptoms and restore patient to her usual health.
The old cough, however, never quite left her for any con-
siderable time, and was always worse from a little exposure.
This lady, however, managed to live and raise a family of
three children, besides losing two in infancy. When she
reached her climaxis she died of a tubercular affection of the
left lung. Her three children showed signs at puberty of hav-
ing enlargement of the thyroid.
Her first born had a prominent thyroid at puberty, arrested
by Calcarea and the Iodide of mercury. Later, ozoena, cured
by Sepia and Aurum. The younger child, a son, showed
struma in childhood, having a fiery redness upon the tip of
nose, glandular cervical swellings, enlargement of thyroid at
puberty, and loss of teeth before fairly advanced from youth.
Calcarea has been an important remedy in keeping back the
more pronounced progress of the hereditary cachexia. One
member has been benefited by cod-liver oil. Perhaps Iodine
would have served well in this family. Iodide of mercury did
discuss a thyroid enlargement in the case of a sister of the
above-mentioned patient. — G. N. B.
We transcribe the salient points of a case reported by J. P.
Geppert, M.D., in the Medical Advance, of Dec. 1881.
166 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Case 6. — During the fore part of June, 1880, was consulted
by the mother of patient concerning a case of tubercular
phthisis. The patient was a young, single man, set. 22; much
emaciated; pulse accelerated, and temperature raised above
normal; hectic fever; night sweats; both lungs showing evi-
dence of serious lesion. Case at time was under charge of a
prominent old school physician in this city (Cincinnati), and
had been for months past.
His prognosis was death within a month, and I have no
doubt the prognosis would have proved true had the same
treatment been continued. The family history on the mother's
side was fair ; that on the father's side was exceedingly un-
favorable. The parents of the father had been induced to
place their son in a mercantile house, and proper precau-
tions had not been taken to prevent the development of con-
sumption, due to confined life, or the breathing of an atmos-
phere deficient in oxygen. The father died shortly after the
birth of the patient (patient being about two years old at the
time of father's death) of consumption, leaving three children.
The eldest was a daughter who died of consumption during
the middle of the year 1878. The second child, a son, is now
living, but troubled with a cough. He is reluctant to receive
any medical treatment or examination, therefore am not able
to speak more definitely concerning him.
Observation teaches us that the last children of individuals
affected with such diseases as consumption in their progressive
development, should show their hereditary effects strongest.
This we see in the case of the sons, and there is no doubt it
would have been the case with the daughter, but for her
changed environment as compared with the sons. The daugh-
ter was very domestic, seldom going from the city and gen-
erally remaining in the house, thus favoring the development
of such hereditary predisposition.
From this history we see the unfavorable position the pa-
tient was in, and would not unreasonably expect such a per-
son to die without special relief by the ordinary therapeutics.
During June, the patient was under my care and received
principally Phosphorus, 30th centesimal potency. One or two
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 167
other remedies were given for special symptoms that presented,
but only for a few days. From the bed-ridden condition in
which I found the patient, he shortly improved so as to go
upon the street, and asked m} r advice concerning a trip to
another state, that he might visit friends and relatives, and
secure a change such as that of atmosphere, food and associates.
Knowing that the change would be that from a crowded city
with abundance of smoke and an atmosphere containing a
high percentage of carbon dioxide, like that of Cincinnati, to
the advantages possessed by a country habitation, I favored
the suggestion and gave him Phos. 30 , to be taken every second
day, with instructions to write me soon after his arrival and
with the expectation of continuing the treatment. Like other
expectations, however, this one was not realized continuously.
Being distant from the patient there was lost that influence
which the personal presence of the physician exerts on the pa-
tient when the individual is properly adapted to perform the
office of healer of the afflicted. The patient passed into the
hands of a local celebrity for the treatment of consumption,
whose prescriptions contained ounces of Oleum terebinthinse,
irritating local applications, and the indulgence of a quantity
of fresh drawn blood of animals daily as food. Under this
troublesome, disgusting treatment he did not improve, but
soon returned to his former low state, and home. It did not
take more than two months of such treatment to overcome all
the good derived from his short homoeopathic treatment.
One Sunday night while at church I was sent for at my
office. The message left was for me to call that evening and
see the patient, not that I could benefit the patient any, as he
would die before morning, but that his distant friends and
relatives might feel that all was done that could be done for
him. I called and found the patient moaning and suffering
greatly. I prescribed for him and promised to return in the
morning. The home relatives telegraphed to distant relatives
that he was dying. At my second visit I found my patient
From my general observation I was of the opinion that low
potencies and alternation would not prevent the patient dying
168 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
soon. I had had a number of cases in somewhat better con-
dition die under the administration of low potencies, and de-
parted from my general practice, feeling that a change and
trial of the higher potencies could not be injurious, and were
they as beneficial as represented, good only could come of the
I was, during my first years, only acquainted with the allo-
pathic method of practicing, but circumstances placed me in
such a position as to receive my medical education in a
homoeopathic college. I was therefore a member of the low
potency division or class of our school. The much repeated
mathematical demonstrations to prove the absence of any
quantity of medicines in the higher potencies sufficient to pro-
duce therapeutic effect, was early presented to me, and even
exerted an influence upon me after the time our relatives in
the Northwest threatened destruction to high potency views
with the weapons of allopathy, under the title of the Milwau-
kee Test. I, too, was taken by the efforts on paper to demon-
strate that good results were only psychological and not due
to the medicine when administered by high potency men. I
came into practice a low potency individual, and previous
habit and instruction have prepared the lines of least resist-
ance in the direction that leads to the administration of low
potencies. Like an imperfect wheel, or one not properly cen-
tered, which produces erratic motions while revolving, I may
not be able to avoid the errors which my organic develop-
ment forces me to pursue when active. The mind of man is a
growth and requires as much training as any other organism
for its proper structure.
This patient was put upon Calcarea carb., and during
months it was the only remed} T employed. He received at the
beginning Cal. carb. 30th for some time, then the 200th, after-
ward the 1000th potency, and the last Calcarea carb. adminis-
tered was Fincke's 107,000 potency. Medicine was given him
at long intervals, sometimes only a single dose a week or fort-
night. As some other indications than those for Calc. carb.
presented after a long use of Calc. carb., a few doses were given.
The improvement in this case was truly gratifying on the ad-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 169
ministration of the highly potentized remedies. Other equally
satisfactory experience I can recall." — J. P. Geppert.
Case 7. — A case from Dr. Arndt presents much interest:
" Mrs. E. G., set. 36, had been given up to die by her family phy-
sician. She came of a consumptive family, her mother and her
mother's parents having died with the disease. She had always
menstruated very profusely, and after having produced upon
herself, within the course of eight or nine years, no less than
seven abortions, her menses assumed the type of recurrent
hemorrhages. Her lungs had always been very sensitive ; has
had more or less cough, at first dry and hacking, later loose and
hollow. Has had pneumonia twice, making a very tardy re-
covery each time.
"At present was convalescing from a third and severe attack
of pneumonia, when some imprudence on her part brought
about an unfavorable change, and she failed so rapidly that
her case seemed hopeless.
"Symptoms: constant hollow, loose cough ; extreme sensitive-
ness of the lungs to cold air, and to a jar; profuse and general per-
spiration at night, of a sour smell. Extreme emaciation ; consti-
pation alternating with watery diarrhoea; great despondency;
constant passive hemorrhage from the uterus of dark, foul blood.
" Calcarea carbonica 30 was the first and only remedy pre-
scribed. Under its use she not only made a good recovery from
this attack, but regained by its long-continued use a surprising
degree of general health." — H. R. Arndt, M.D.
Case 8. — "Mrs. F. H. A., set. 23, tall, large, of fair complexion
and of lymphatic temperament, mother of one child, herself
the only child of a mother who died of phthisis at the age of
twenty-seven years. Mrs. A., when a child, was very sensitive to
changes of weather, and spending the greater part of her child-
hood in travel and in boarding-houses, suffered frequently
from colds, with dry, hacking cough and hoarseness. At the
age of twelve years she went to live in one of the Southern
States. Commenced to menstruate at the age of thirteen ;
menses fairly regular, normal, but quite profuse. When fifteen
years old she suffered from a milky, copious leucorrhcea, ac-
companied with great weariness. Soon after, her appetite be-
170 PHTHISIS PULMONALIS :■ TUBERCULAR PHTHISIS.
came fitful, and, eventually, she was placed under medical
treatment for dyspepsia and a chronic diarrhoea characterized
by very frequent, watery stools of foul odor, with marked pros-
tration and general emaciation. At the age of nineteen she
commenced to improve, and when she married, some two or
three years later, she had become a large, finely-formed woman,
seemingly in the enjoyment of excellent health. She bore one
child; labor was normal; recovery somewhat retarded on ac-
count of her husband's failure in business. While nursing
her child, she experienced great exhaustion ; considerable ner-
vousness, dull frontal headache, palpitation of the heart, a
tendency to cold, clammy perspiration, flying, stitching pains
and feeling of weakness in the upper chest, hacking cough,
without or with scanty expectoration, leucorrhcea, backache
and a tendency to moodiness. She improved somewhat after
weaning the child, but continued to cough more or less, failed
to regain her former cheerfulness, continued to lose flesh, and
experienced a complete loss of all sexual desire, bordering, at
times, upon aversion. Six months ago she ceased to menstruate.
Condition of the patient at the first examination: she ap-
pears gaunt, hollow-eyed, greatly emaciated; she coughs little,
but complains of stitching pains in the upper chest; loss of appe- ,
tite; constipation; fluttering of the heart upon the slightest
exertion ; is weary of life, and but for her love of husband and
child would welcome death. Constant coldness and dampness of
the feet; tongue covered with a thick, white, pasty coating; bad
taste in the mouth; full, heavy, stupid feeling in the head,
particularly in the morning; pulse 90. Examination of the
chest revealed a remarkable degree of emaciation, the breasts
consisting of elongated, dependent folds of flabby skin, and
the intercostal spaces showing like deep, distinct hollows; flat-
ness and narrowness of the chest, with hollowness in the sub-
clavicular region; dulness in the upper chest to percussion;
number of inspirations per minute but slightly increased in
Frankly acknowledging her bad family history, the patient
expressed her conviction that her chief troubles were of uterine
origin, and that she was absolutely free from tendency to
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 171
phthisis. In view of the entire history of the case she received
Calcarea carbonica 30 , one dose every three hours. After taking
a few doses of the remedy, a violent diarrhoea appeared, pos-
sessing all the characteristics of a Calcarea diarrhoea. On the
third day she menstruated normally.
I heard nothing from the patient until some six weeks later;
her husband reported marked changes in his wife's condition ;
she felt better in many respects ; she had commenced to gain
flesh; showed some sexual desire and her breasts were rapidly
assuming their former plumpness. But she had again passed
by her menstrual period. Gave Calcarea in the 200th dilution.
Again menstruation appeared within a few days.
The result of the prescription may be condensed as follows :
menstruation became regular, leucorrhcea disappeared, appetite
and digestion became normal, pains in the chest subsided, and
with it nearly all former symptoms of lung trouble ; coldness
and dampness of the feet no longer troubled her; she enjoyed
life once more, became pregnant, and in due time gave birth
to a pair of healthy children.
The case is remarkable only in two respects: 1. It is an
almost typical Calcarea case. The remedy was so clearly in-
dicated in the totality of all her symptoms, dating back to the
days of her early childhood, that the merest tyro in medicine
would have recognized it ; 2. The curative effect of the remedy
was so remarkable in its promptness, and showed itself so plainly
in every part of her organism, that it makes the case worthy
of at least passing notice." — H. R. Arndt.
Lungs and Thorax. — Aching pain, with soreness of chest to
the touch. Pains on the right side located at the sixth rib;
shift to the left side, locating a little higher up. Sore pain about
the sternum and clavicle. Contraction of the chest, with difficult
Cough. — Cough with hoarseness afflicting patient day and
night; cough with soreness and dryness of the throat. Cough
with yellow expectoration, more in the morning.
Accompaniments. --Face is pale, sallow, yellowish or earthy ;
172 PHTHISIS PULMONALIS : TUBEKCULAE, PHTHISIS.
often has a pimply eruption ; cold sweat appears on the face and
coldness of the body is a prominent symptom (Sil.). Nervous
symptoms are : "weakness, languor, weariness on going up stairs,
has to sit down from exhaustion and shortness of breath. Asso-
ciated with these symptoms we not unfrequently have diarrhoea
and leucorrhoea. Among the anal symptoms itching hemorrhoids,
and small furuncles near the anus.
Symptoms of the larynx are : frequent hawking to clear the
voice ; breathing is short ; sighs involuntarily. Calcarea phos-
phorica has proved a valuable remedy in chest difficulties,
associated with fistula in ano. It corresponds pointedly to that
class of cases where faults of secondary assimilation exist, and
where the dyscrasia has a tendency to involve osseous and
dermoid tissues, especially if hemorrhoids exist, and if sinuses
form about the outlet of the great cloachus, the indications are
It has less of the true albuminoid diathesis than is presented
in Apium, but in the faulty workings of the functions of the
excretory organs, and the separating process that preserves
living structures from degradation by associating with the
effete, Calcarea phosphorica is an agent of high rank.
It thoroughly meets the diathesis which is the parent of
rachitis and tabes mesenterica. There may be presented occa-
sionally doubts as between the use of the phosphate and car-
bonate of lime, as there are many analogies, and they actually
meet a similar dyscrasia. I should think the phosphate usu-
ally a better similimum for acute affections of the lungs than
Also to cases arising from an old pneumonia to which case-
ous degeneration is added, and to guard against such a turn
of the disease. We think Calcarea phosphorica in its relations
to pulmonary phthisis will hardly be the similimum in so
large a number of cases as Sulphur, but will supplement Phos-
phorus often to great advantage.
It occupies a ground between Calcarea carbonica and Phos-
phorus. The similarity of action between this drug and
Tuberculinum, we should expect to be quite marked if not
identical; yet from my own observation I should decide they
were not identical in curative reaction.
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 173
The hypophosphates which have been presented with such
claims by certain physicians no doubt owe whatever merit
they may have to this agent ; but in quite too crude a form to
accomplish that which might be with the homoeopathically
prepared drug carried well up in dilution or trituration.
Lungs and Thorax. — Deep stitch in right lung from without
inwards; stitches in the upper part of the left side of the chest
after coughing ; aching in the upper part of the right side of the
chest, at times attended with burning as of red hot coals ; aching
from right apex through to scapula. (Left, Myrtis and Sulph.)
Sensation of weakness and fatigue of the chest. Dunham
mentions the symptom, "breath is short and chest tired on
Cough. — Cough after the slightest cold ; in the morning when
rising from bed, or when leaving a warm room and entering a cold
one; short cough in the evening; cough causing vomiting and
retching in the evening ; violent cough with discharge of a quantity
of yellowish pus, accompanied by stitches in the left hypochondrium
when breathing (right, Kali carb.). Raue gives, " cough in hard
spells not ceasing until masses of offensive sputa are expecto-
Often there is cough accompanied with stitches in the head.
Accompaniments. — Feeling the want of air and need of a fan
is quite characteristic.
Raue gives, "nose-bleed in the night; hoarseness in the evening."
Hering gives, "hectic fever; exhaustive night sweats; sweat
profuse, putrid or sour; sallow complexion and sunken fea-
tures ; vital forces nearly exhausted.
Dr. Berridge gives as characteristic symptoms, "cough
worse by day and in the open air; also coughs worse during sup-
per; soreness of the chest and heat of the body when coughing;
sensation at night as if choking from mucus in the throat when
coughing; the choking alleviated by sitting up or moving; itch-
ing in throat extending to chest, worse when coughing."
Noack and Trinks say, "Adapted to persons of excessive sen-
sibility to change of temperature; to cachectic individuals whose
174 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
vital powers have become weakened ; to gangrene of the lungs ;
to pulmonary phthisis passing from the stage of inflammation
to that of suppuration of the lungs ; to incipient tubercular
phthisis with tuberculous discharge ; to stitches in the chest
and short breathing."
Dr. C. C. Smith sends me these guiding symptoms for Carbo
vegetabilis : " Frequent and easy epistaxis, generally worse night
or forenoon, followed by pain over chest and pale face ; hoarse-
ness each evening at 5 o'clock."
There have been many statistical tables brought forward to
show that laborers in anthracite coal mines have an immu-
nity from tubercular affections of the lungs. Mines in Eng-
land, France, Belgium, North America and others, have fur-
nished tables tending to show that coal-miners as a class are
largely protected from phthisis. Such being the fact there
must be a reason for the same. Different theories have been
put forward to explain this immunity, such as equability of
temperature, the presence of the bromides and iodides in small
proportions in the coal, and even the increased pressure of the
atmosphere has been adduced as the cause. It is not proba-
ble that any of these reasons give any important part of the
solution to the question. It is well known that carbon has a
power to arrest the processes of transformation going on in
what is called the putrefactive fermentation. Presumably the
solution of the question will be found to be in some influence
upon molecular movements of the microscopical particles in-
haled, if such immunity exists. The leading elements out of
which albumen is produced (the chief constituent of tubercle)
is carbon. Whether there be a law that matter of the same
kind upon one plane can be used to arrest degrading trans-
formations upon another plane, is a pertinent question to ask
here, and I think we shall answer it in the affirmative. Molecu-
lar energy passes from one molecule to another, aiding its
movements and transformations when proceeding under or-
ganic laws, else how are we to explain the phenomena of like
allying with like, also fermentation and catalytic action. I
was once called to see a lady with a calcareous impaction of
the ileum. We were unable to decide what the tumor was,
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 175
but she had a chalky colored diarrhoea, and a few other symp-
toms which led us to give her the 200th of Calcarea carbonica.
She soon discharged large quantities of cretaceous matter from
the bowels, and the tumor was gone. Be the explanation what
it may, there is no doubt that Carbo vegetabilis has been of
service in some forms of pulmonary phthisis. Dunham speaks
of its applicability to cases of suspected slow tuberculosis, depres-
sion not preceded by erethism or excitement.
In bronchiectasis, where the cavities are holding fetid and
decomposing matters, we should naturally look to Carbo vege-
tabilis to ameliorate the condition.
Some of our physicians speak well of a weak spray of car-
bolic acid in the first stages of phthisis.
Clinical. — Case 1. — A young man, set. 17, who had for-
merly suffered from herpes, experienced an exhausting cough,
with steady, continuous pain in the chest of three or four
month's standing. He is obliged to cough long and hard un-
til he raises; expectoration consists of chunks of thick, green-
ish, fetid, purulent matter; especially copious in the morning;
loss of appetite; loathing of meat and salty food, and at times
vomiting in the morning ; difficulty of breathing when walk-
ing; general emaciation and prostration ; profuse night sweats.
Cured by repeated doses of Carbo vegetabilis." — Knorre, in
Allg. Horn. Zeitg., V., 185.
Dr. McLaren reports his trial of Petroleum, which is a car-
bonaceous product, in phthisis, in the June number of the
Homoeopath, which I transcribe : " During my temporary resi-
dence in New England many opportunities were afforded me
for the study of pulmonary diseases. My attention was called
to the above drug by a very intelligent gentleman from the
oil regions of Pennsylvania, who reported several pronounced
cases of phthisis in the first stage as having been cured by it.
He also informed me that the families of those living in that
region very seldom consulted a physician for any throat ail-
ment, as they found prompt relief in the external application
of the drug ; also diluted as a gargle. From these statements
I was led to use it in phthisis, with the following results :
"Case 2. — This case was one of incipient phthisis; respira-
176 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
tion was broncho-vesicular; marked increased vocal resonance;
night sweats; dyspnoea; poor appetite; pulse, 112. Having a
preference for the sixth dilution, I prescribed Petroleum 61 .
There was no improvement until the second week. The pa-
tient was discharged cured at the end of three months.
" Case 3. — A young woman, an operative in a cotton cloth
manufactory, whose parents and only brother had died of
phthisis, consulted me as the last hope. Jerking respiration ;
coarse bubbling rales ; broncophony and whispering bronco-
phony ; pronounced cough, with muco-purulent respiration ;
pulse, 118; dyspnoea severe; almost total loss of appetite.
This case seemed hopeless, but I determined to see how much
virtue there was in Petroleum. The record of my case does
not state what decided my preference for the third potency.
Lung exercise, diet and all usual auxiliaries were enjoined.
At the end of a week my patient was losing ground. I pre-
scribed the 12x, and continued it for two weeks without any
hopeful results. I decided to alternate with Calc. phos. 3x , and
at the end of a week there was evident amelioration of all the
active symptoms. This treatment was continued for four
months, and the patient was so much improved as to be able
to walk a mile every day. I know of no remedy which so
promptly lowers the pulse and at the same time modifies the
Lungs and Thorax. — Soreness in the chest. Tightness of
the chest, must frequently take a long breath. Stitching in ster-
num at deep inspiration, and when lifting; stitches deep in chest
going to back; stitches near the nipple going down toward um-
bilicus when breathing; stitch during expiration, connected with
one in left shoulder-joint.
In the later stages of the disease: loud rales when coughing;
shortness of breath when walking in open air.
Cough. — Troublesome, dry ; comes on after getting warm when
one has been in the cold air. Concussive action of cough causes in-
voluntary passage of urine. Expectoration in the later stages of
a heavy creamy consistence, whitish in color.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 177
Aggravations. — In the open air and early in the morning.
Ameliorations. — Cough often relieved by a swallow of cold
Accompaniments. — Causticum patients are subject to cold
feet; have a tendency to perspire when walking in the open air;
have a great deal of internal chilliness; sweating and chilliness
frequently alternate. Voice is weak and hoarse; tendency to
hacking and scraping of the throat, especially in the morning;
rough feeling in throat; also tickling and crawling sensations;
breath is short on walking. Complexion sickly and yellowish
Psychological symptoms are: easily vexed; inclination to feel
offended; whining and complaining ; great nervous irritability ;
full of apprehensions; absent-mindedness; weakness of memory;
and possibly suicidal tendencies; disgusted with the idea of
wasting away with consumption.
Dr. Dunham places much stress upon the hoarseness and
aphonia: " Hoarseness toward evening with a dry tickling cough ;
the prover feels a sensation as if he could not cough low enough
to start the mucus ; rawness and tickling are felt in the throat-
pit ; patient inclined to backache, especially in the coccyx."
From the well proven affinity that Causticum has to tracheal
and laryngeal membranes, its chief value in respiratory affec-
tions has been thought to be in aphonia and catarrhal troubles.
The laryngeal phthisis, which authors have mentioned as cured
by it, has really been considered ulcerative bronchitis, not of
the tubercular habit. Although these cases are undoubtedly
for the most catarrhal at the beginning, we are not so sure but
that we have caseous exudation in the end. We are pretty
well convinced that we have had cases of this character ; in
one case the disease was arrested for two or three years, then
tuberculosis carried our patient off in other hands. We should
place the chief value of Causticum in cases where an old ca-
tarrh was progressing downward upon the lungs. Such is the
course of many of our cases of pulmonary consumption. Tu-
bercle does not invade the lung tissue proper for a long time,
but the mucous tissue ; later caseous exudation in the apices.
Clinical. — Case 1. A lady past fifty years, subject to a chronic
178 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
cough, was prostrated by taking a severe cold ; had been af-
flicted with nasal and bronchial catarrh for many years. Com-
plexion was of a dingy earthy hue ; voice altered by obstruc-
tions and thickening of nasal passages ; voice rather husky ;
she was impatient and irritable in disposition. Following her
acute attack which prostrated her to the bed with considerable
fever, was a severe cough of a hollow sounding character ac-
companied with a heavy white muco-purulent sputum, coming
away in heavy masses. Fever partook of a hectic character
with night sweats. Patient was easily affected by changes of
temperature ; could not bear the heat of the fire. Cough was
ameliorated by taking a little cold water. Bronchial sounds
were heard under the right clavicle. There was dulness at the
supra and infra-clavicular spaces. Case was so far benefited
by Causticum that patient was up and about her family duties
for four years ; was then taken down and being attended by
an old school physician, we know little further, save that she
died with what was called consumption. — G. N. B.
Case 2. Dr. Berridge mentions a case of catarrh where the
cough was worse nights and in a warm room, and better by
drinking cold water, cough accompanied with smarting in
chest, cured by Causticum.
Case 3. A good typical case came into our hands in the
earlier years of our practice. A lady, set. 35, had been for
some years subject to catarrhal troubles. She was of slender
make, pale complexion with a little redness about the nose as
if she might have an eruption ; scanty menstruation appearing
only in the daytime ; had complete aphonia which had lasted
six weeks. Much shortness of breath, with a hollow dry cough,
worse nights and mornings ; cough aggravated by breathing cold
air, but relieved by drinking cold water. Gave Causticum, voice
returned in two weeks, other symptoms mending to correspond.
She recovered so as to enjoy her former health. Living at a
distance she was not my patient beyond the few weeks re-
quired to establish her health sufficiently to return to her
family and its duties. She died of consumption five or six
years later in allopathic hands.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 179
Lungs and Thorax. — Patient feels as if chest did not expand
enough, so finds it difficult to take full inspirations. Tightness
across the chest; short panting breath; pleuritic stitches; rat-
tling in the chest when lying down ; sharp thrusts directly through
the chest from sternum to spine, while sitting.
Cough. — Short, hacking cough from itching and titillation
in the throat. Cough excited by deep inspirations; violent
cough with pain in the chest ; cough with pain in both sides of
the abdomen ; nightly cough ; cough with yellow expectoration,
tasting like bad eggs ; purulent expectoration ; cough from a dry
spot in larynx.
Aggravations. — At night, and when lying down.
Accompaniments. — Pimples upon the chest; sore to the
touch; pain in the mammae; hardness of right mamma ; glandu-
lar swellings ; inclination to perspire during sleep, even of the
cold limbs ; difficulty of breathing, both when at rest and in
motion ; vertigo when turning over in recumbent position ; com-
plexion pale and sickly; falling out of the hair; diarrhoea
with tremulous weakness after every stool ; patient easily excited
and greatly concerned about little things ; nervousness passes off
in the open air.
Conium patients are apt to be drowsy in the evening, but sleep-
less after midnight, and annoyed with frightful dreams. A
very common symptom is palpitation of the heart after
The action of Conium seems to be primarily upon the spinal
cord, corpora striata, and the ganglionic nervous system. It
is among our best remedies for managing abnormal action in
the greater and lesser glands so definitely related to the scrofu-
lous diathesis, which is also the parent of tubercle.
It expresses exhaustion of nervous energy ; voluntary mus-
cles are weak and paralyzed ; mammary glands waste away.
Conium has obtained high rank as a discutient, and possi-
bly its fluidifying power whereby curdy and cheesy matters
are made more ready for the absorbent vessels, explains much
of the modus operandi of its curative action in our consump-
180 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
tive cases. It has been used in both the high and low poten-
We have had no experience with Conium in the ulcerative
stage of phthisis for ourselves ; perhaps have not tried it when
it would have served ; yet it has a fine clinical record dating
back to the earliest masters in our school.
It will be found most serviceable to the female constitution,
and in such cases as have uterine and mammary complica-
tions or enlargements, and irritation of the larger glands.
Clinical. — Case 1. Miss S. G., aet. 50; rather tall; very slen-
der; muscles so attenuated as to amount almost to atrophy; ner-
vous ; at times troubled with insane hallucinations ; aversion
to men ; suspicious of some magnetic influence having been
gained over her. Had a brother who committed suicide ; a
sister who died of pulmonary phthisis beginning with he-
moptysis. The mammary glands are shrunken, with active
sexual desire ; glands sensitive, with occasional stitching
pains. Had a hard fibrous tumor removed from the left gland
by the sloughing process, some years ago, size of half a but-
ternut, split longitudinally ; later hard nodule showed itself
in right mammary gland ; is subject to a dry, hacking cough,
coming on only when lying down. Conium 200 has prevented
further advance of the tumor, and kept under control the
trouble about the lungs, but has not cured the psychological
symptoms. — G. N. B.
Lungs and Thorax. — Great weakness of the chest, cannot
bear to talk. Feels better lying quiet in a horizontal position.
Cough. — Deep, hollow, spasmodic, excited by a sense of
roughness or scraping in the roof of the mouth or trachea. No ex-
pectoration in the morning, but small quantities of yellow,
jelly-like mucus thrown off with difficulty in the evening. Some-
times expectoration with a little dark blood.
Aggravations. — About midnight or toward morning; from
getting heated; also from drinking cold things (Ars.), and by
talking and walking in the open air.
Accompaniments. — Chill more internally, beginning with cold
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 181
extremities, then spreading over the body, but with face warm. In-
ternal chill with external heat. One hand hot the other cold;
sweat on upper part of the body. Violent but not very rapid
beating of the heart. Pulse slow when at rest. Hoarseness
early in the morning, painful dyspnoea, worse when walking.
Great fear about the future, which becomes worse about 6 P.M.
Experiments with digitalis upon animals show that this
agent acts powerfully upon the lung tissue, and the autopsical
features have a close analogy to the immediate antecedents of
tubercular deposition. The lung tissue is denser, especially
that of the right lung, as if hepatized, and is of a violet color.
The blood-discs are somewhat altered, and the blood loses its
power of coagulating when death follows from the effects of
This seems to indicate a power of defibrinizing the blood,
and if, as we have argued, phthisis is essentially a hyperfibri-
nosis, it would seem that it might be utilized in the disease.
The heart usually sympathizes strongly with all organic dis-
turbances where Digitalis is indicated.
Noack and Trinks speak of its action being especially on
the sympathetic nerve and the cardiac plexus ; also of its ap-
plicability to persons of a sanguine temperament, with light
hair and soft muscles, and to the scrofulous diathesis.
Dr. Beddars testifies that as a general rule when he has all
possible evidences of the existence of tubercles in the lungs, he
gives small doses of Digitalis, and that it has proved eminently
Frequently among the earlier evidences of tubercular affec-
tion of the lungs are blood-discs in the sputum, or hemopt}^sis.
The peculiar action of Digitalis on the heart, point to it as
prominently a remedy in all cases showing this hyperaemic
tendency of the pulmonary blood-vessels. We regard the hem-
orrhagic diathesis when tending to localize upon the lungs,
as especially suggesting Digitalis. It is in the period just
preceding deposition and that intervening between depos-
ition and softening, that it will probably be found most ser-
viceable, although it may help much to allay the excessive
cardiac action which is often so troublesome in the later stages.
182 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
In many respects Digitalis is the analogue and support of
Phosphorus, which also has the blood-stain in the sputum, the
morning aggravation of the cough, and the aggravation from
exercise in the open air and from talking.
It is also prominently a remedy in hepatization of the lungs,
a condition it is competent to produce proximately, at least,
the pathological condition showing the lung to be dense with
crepitating tissue. Phosphorus destroys the fibrin also, so that
no trace of it can be seen even with the microscope; both
these agents will serve us best in the commencement of our
affections, particularly when associated with the hemorrhagic
diathesis. As a check upon excess of fibrin in the blood, and
as a hemastatic, we are not likely to overestimate its value.
The more pronounced the cardiac symptoms the more is it
likely to serve our patients.
Lungs and Thorax. — Pains in left lung moving in waves ;
hemoptysis of bright red blood, caused by a cold or a pro-
tracted cough, attended by a tickling sensation in the larynx ;
stitches here and there in the chest; lancinating pain in the
middle of the sternum back to the spine when sitting, which goes ■
off on rising; pain in right side of chest, which goes to the back on
All chest symptoms worse by change from hot to cold.
Cough. — Hoarse, dry, rough and barking cough; panting cough,
worse at each deep inspiration; loose cough, with copious ex-
pectoration. Sputa; mucus in abundance; blood and mucus;
greenish or greenish-yellow mucus.
Aggravations. — By lying down and from warmth of room.
Ameliorations. — By being in the open air.
Accompaniments. — Chill, commencing in the back, not re-
lieved by warmth; diarrhoea; emaciation; offensive night-
Lungs and Thorax. — Soreness in chest worse from inspira-
tion; pain and soreness behind the sternum; heart feels as if
in too small a place.
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 183
Pain through right nipple when breathing.
Deep-seated pain in left side and right shoulder.
Cough. — Precedes chill, sometimes night before.
Rough scraping cough ; must support the chest with the hands
(Bryonia) ; loose cough during apyrexia.
Cough is apt to provoke retching, as in Drosera.
Accompaniments. — Chills, usually occurring about 7 a.m.,
or from 7 to 9 a.m., a bad cough often attending both chill and
fever stages; nausea during chill; vomiting of bile at end of
Eupatorium is fairly entitled to a place among our reme-
dies for phthisis pulmonalis based upon a malarial cachexia.
Thirst before chill, and nausea when fever sets in are character-
Lungs and Thorax. — Flying pains in the chest with palpita-
tions; inter-scapular pains; left lung often feels as if oppressed
above or at the nipple, where there is soreness, making breathing
Pains in apex of lungs embarrassing breathing.
Cough. — Spasmodic, from tickling in trachea; at night
must sit up to raise sputa. Sputa ; copious, purulent, greenish or
frothy; worse morning; or scanty and frothy with streaks of
Slight cough with hemoptysis of bright red color, occurring more
frequently in morning, though may occur at night, cough worse
from drinking wine or brandy, from use of quinine and from
Accompaniments. — The face flushes easily, and veins feel
hot; palpitations and dyspnoea. Patient feels better sitting up,
though compelled to lie down from a feeling of weakness. It has
been found a valuable remedy for hemoptysis following loss
of fluids and onanism, also from suppression of the menses.
With the heart symptoms we have the bellow's murmur and
throbbing of the vessels.
Ferrum fever is more marked in the afternoon and evening;
the chill is attended with a hot and red face, with thirst as in
hectic fever; sweat profuse and long-lasting.
184 PHTHISIS PULMONALIS : TUBEKCULAE, PHTHISIS.
We are persuaded that iron has been used in tubercular
cases in altogether too crude a form. We also believe an im-
prudent use of iron in cases of ovaritis and menstrual arrest,
has resulted in provoking rapid tubercularization of the lungs.
This mistake often occurs in treating girls from the age of
fourteen to twenty ; and yet it would seem from the peculiar
action of Ferrum, that if properly used, many of these cases of
anaemia and possibly the more acute affections of the ovaries
might be successfully treated.
We have personally observed the rapid production of tuber-
cle in the lungs from Ferrum muriaticum when given in over-
doses to tubercular patients. If it will produce tubercle it
should arrest tubercle when properly prepared and prescribed.
The person on whom our observations were made was of a
nervous sanguine temperament, rather tall and spare. She
had taken iron some ten days only, when the tubercular dul-
ness had spread over double the space previously occupied,
and the heart's action became so excited that there were strong
jerky contractions occurring frequently at the time of our ex-
amination. Ferrum then would seem to be preeminently
adapted to the period of active exudation and with a high
grade of arterial excitement; also to a condition of active con-
gestion with tendency to hemoptysis. The peculiar action of
Ferrum upon the blood-corpuscles also affords the inference
that those molecular changes connected with the transforma-
tion of tissue can be modified with Ferrum in a way to benefit
our tubercular cases.
Favorable as may be the view we have taken on this subject,
it is undeniably true that more harm than good, thus far, has
come from the use of this remedy. It remains to be seen if
with the advanced dilutions our record shall be improved.
We confidently predict that with the use of the thirtieth po-
tency and upward, chosen carefully in accordance with the
law of similars, disappointment of reasonable expectation in
this very potent remedy, will not follow.
In one chlorotic case we witnessed a remarkable action of
Ferrum muriaticum when taken in a little wine. Patient
gained color, expectoration decreased, hectic fever subsided,
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 185
and strength improved. She died from an attack of pneumo-
nia before cure was completed.
In some cases of extreme emaciation and debility following
drains upon the vital forces, we have succeeded wonderfully
with the iodide of iron. One case of impotence, in a scrofulous
person, whose two brothers and a sister died of consumption,
and who himself had reached the stage of advanced marasmus,
was cured in my early practice with this remedy prepared
freshly by adding a little water to iodine and iron filings, and
preserving the preparation by the addition of sugar.
The blood changed color, flesh returned, and the impotence
which was so bad that semen was lost daily without erections
was cured in a few months. I have little doubt but for the
Ferrum iodatum my patient would have died with phthisis
pulmonalis in a year or two at longest. In this case and the
case improved by muriate of iron, the complexion was not of
the florid kind with that of Mrs. Hall where tubercles were so
rapidly multiplied under the action of Ferrum muriaticum,
nor was there any considerable acceleration of the pulse in
either case ; complexion of one was a dingy yellow or sallow
and the other more of an earthy hue. Our literature does not
furnish, so far as I know, clinical experience to the extent of
giving Ferrum and its compounds their proper value in the
treatment of phthisis pulmonalis.
Clinical. — Case 1. — " A woman, set. 48, mother of several
children, of sanguine temperament, slender, tall, had three at-
tacks of pneumonia during her childhood and had been treated
by bleeding, followed by frequent nose-bleed, spitting of blood,
diarrhoea, catarrhal affections. In her thirty-second year dis-
appearance of menses ; flat, narrow, lengthened thorax; depres-
sion in the subclavicular region; loss of strength, emaciation,
chilliness and shiverings in the evenings with subsequent
fever and night sweats, cough at first dry, later accompanied
with green, purulent expectoration containing little lumps of
a cheesy substance ; oppression of the chest, likes to lie on her
back ; tympanitic sound on the sides of the thorax ; bronchial
186 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
breathing, and near the clavicles vesicular crepitation. Gave
Ferrum iodatum (20-30), three to four grains each day, lessen-
ing of copious expectoration, no more oppression of the chest,
cough less frequent, expectoration only of tracheal mucus,
disappearance of the fever symptoms, improved appetite, im-
proved regularity of the bowels, stools greenish-black; she
gains strength rapidly and has become cheerful and hopeful ;
this improvement has taken place in six weeks." — Altschul,
Pr. Mon. Schriften, 1, 68.
HEPAR SULPHURIS CALC.
Lungs and Thorax. — Sensation as of drops of hot water in
left chest. Spasmodic constriction of the chest after talking.
Stitching pain in side of chest towards the back.
Cough. — Cough with constant hoarseness; sensation as if
there were a fishbone in the throat. Cough brings on vomiting;
coughs when eating (Lach.). Cough barking, wheezing, chok-
ing. Expectoration bloody, frothy, with tuberculous products.
Aggravations. — Worse before midnight and in the morning.
By cold air coming in contact with any part of the body; hence
great dread of undressing. By recumbent position.
Accompaniments. — Chills from the least exposure of the body ■
to the air. Paleness upon the least exertion, followed by burning
redness of the face, and heat in .the palms of the hands; at this time
perspires easily. Stomach is apt to be out of order; longing
for sour things.
Dunham gives the symptom of " feeling as of a hard body in
the epigastrium, immediately followed by a hemoptysis."
Guernsey : " Person smells sour."
From the known value of Hepar in suppurative actions, as
well as its power to correct glandular derangements, it sug-
gests itself in the suppurative or ulcerative stage of tubercular
disintegration. The low vitality and extreme sensibility to cold
of many of our consumptives, those who come to us bundled
heavily to keep out the cold even in pleasant weather, will
often be met by Hepar better than by any other remedy. Cer-
tainly as an adjunct to some other of our most important
remedies it is indispensable.
phthisis pulmonale: tubercular phthisis. 187
Dr. H. C. Allen reports a case of protracted catarrh cured by
Hepar, where the cough was worse night and morning, and vio-
lently aggravated by recumbent posture. Associated with this
was the dread of undressing, because of the terrible paroxysms of
coughing provoked by change of temperature, impressing the skin.
Cough was aggravated by exposing any part of the body to
Lungs and Thorax. — Sensation of weakness in the chest.
Stitches and burning in the chest after a dry cough. Sharp, quick,
Cough. — Dry morning cough from tickling in the larynx.
Cough provoked by constant tickling in the trachea, and under
the sternum. Cough with expectoration of large quantities of
transparent mucus, often streaked with blood.
Accompaniments. — Unaccountable weakness and loss of
breath on going up-stairs; laryngeal cough with diarrhoea, slow
fever, night sweats, and emaciation.
This remedy seems especially adapted to that class of pa-
tients who emaciate while eating well; indeed, they often have
Another class of cases to which Iodium will be found ser-
viceable has goitre in the family, or possibly in themselves, or
traces of partially cured goitre. Other conditions indicating
its adaptability are : scrofulous persons with low cachectic
state of the system ; women with dwindling of the mammae (Con.),
or shrinkage of the adipose tissue, mammse are sore, with uter-
ine disturbances (Conium); women with amenorrhcea, with
Hughes says: "It seems capable of doing everything but
checking the deposition of fresh tubercle."
Perhaps we could do more with higher attenuations.
Lippe gives "emaciation with good appetite."
If it should be determined that the value of cod-liver oil
was owing to the presence of Iodine in solution in infinitesi-
mal doses, such cases as are reported cured by oil, would
largely go to the credit of Iodine. It is worth while to collect
188 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
data from the cases to which oil proves curative; if of the
Iodine type, the probabilities will be very greatly in favor of
Iodine being the curative element.
Some have reported benefit from the inhalation of Iodium
in tubercular affections of the lungs; it has such a value for
scrofula, it would seem as though we should find a class of
cases where it will prove a leading remedy. In the early stage
of the disease, when emaciation first declares itself, especially
if there be a good appetite, and flesh continues to shrink all
the same, we should expect Iodium to act beneficially.
Itching in lungs low down, and extending up through the trachea
to the nose, and itching of the tip of nose before coughing, are char-
acteristic symptoms. Hering thinks it agrees best with per-
sons with dark hair and eyes. Mentions it for overgrown boys
with weak chests. Dr. Muller gives an interesting Iodium
Clinical. — Case 1.— "A lady, ast. 27, was attacked by influ-
enza which was followed by hoarseness, cough, dyspnoea, de-
bility, and emaciation, which steadily progressed. Cough was
quite suffocative. Took Phosphorus and Hyoscyamus, but
with no improvement. A later and more complete catalogue
of symptoms gives us: excessive lassitude and weakness, is.
hardly able to walk twenty steps; considerable emaciation;
dyspnoea from the least exertion; irritability with hot flushes
and palpitation ; dry heat every afternoon, with thirst and dull
feeling in the head; restlessness and insomnia at night; per-
spiration toward morning; little appetite, gastralgia and con-
stipation. Voice hoarse and weak, without timbre. Constant
pressure in the throat, with burning, including larynx, trachea
and bronchi; a sensation of rawness which provokes an incli-
nation to hem and cough ; sensation of weight and pressure in
the chest; a short dry cough day and night, with an exacerba-
tion two or three times daily of severe spasmodic turns, with
breathlessness, heat in the face and head, and exhaustion.
Sputa tough, scanty and thick, with occasional streaks of
blood. Menses scanty, almost absent. Skin dry, pale, of dirty
gray color. The superior clavicular region depressed, espe-
cially on the right side; feeble and irregular motion of the
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 189
thorax when breathing; sound of percussion empty on both
apices; on the apex of right lung bronchial respiration, lower
down indistinct and slightly vesicular breathing; beat of heart
strong; second pulmonary sound increased on the neck; ven-
" Diagnosis, pulmonary phthisis. Case was now put upon
Iodium 3 with very decided benefit. Dose, one drop morning
and evening. Mercurius sol. 3 was given after four weeks, for
some symptoms that did not seem to yield, for the evening
dose, but we should say with doubtful utility.
" Voice improved, cough decreased, and improvement went
on so effectively that the lady was in a condition to become
pregnant after four months. Was finally delivered of a child
at full term.
" Though not fully cured perhaps, as the clavicular region is
still depressed, and she becomes easily fatigued, yet she has no
cough, and her voice is clear and flesh fairly good."
Lungs and Thorax. — Pains from back to sternum or shooting
pains from middle of sternum back between shoulder-blades. Sharp
pain through apex of left lung to shoulder-blade (Sul.).
Cough.— Wheezing cough, with expectoration of tough stringy
mucus, pulling out into threads.
Aggravations. — Worse while undressing (Hepar s. c), and
Accompaniments. — Emaciation, night-sweats and quick
This remedy has great power as a solvent, and acts as a
check to plastic exudations in throat and within the respira-
tory tract, and no doubt is adapted to the management of a
certain class of cases of a tubercular character, especially to
fleshy people who become tuberculous, or have caseous affection
of the glands. It is adapted to light-haired persons who have a
tendency to baldness or loss of hair; also to persons subject to
Clinical. — Case 1. — "Mrs. C, set. about 28, had taken cold in
the early autumn. From repeated exposures came a cough
190 PHTHISIS PULMONALISI TUBERCULAR PHTHISIS.
which rapidly grew- worse, accompanied with extreme emacia-
tion; has been a plump woman. Symptoms are : broken feeling
in back after walking, eased by sitting bent forward: dragging
down feeling in the back and hypogastrium; violent cough,
worse in the night, better by lying on the left side, worse on the
right side and still worse when lying on the back. Sharp pain
through the apex of the left lung to the left shoulder blade
(Sul.) and through the base of the right lung to the right shoulder
blade; expectoration thick, yellowish, stringy and offensive;
coughs always after the least mouthful of food or drink and worse
from a change to cold air; great thirst; profuse night-sweat
and also day-sweats which are worse about the head; pulse
weak, 120 beats per minute and quick. This was not a case
of pneumonia; the history, the character of sputa and physical
signs were against it, and it was something more than acute
bronchitis. I found on examination distinct evidences of a
small cavity in the upper part of the left lung, and some tu-
bercular deposit in the lower part of the right lung. Gave
her Kali bichromicum, third decimal; patient made rapid
progress and to a fair degree of health, though not as strong
as formerly. One dose of Phosphorus 500 (Tafel) w r as adminis-
tered before patient was discharged." — H. N. Martin.
Case 2. — Mrs. M. P., set. 38, rather fleshy and of light com-
plexion, has been coughing for several weeks and from family
history fears consumption; she has sharp pains accompanying
her cough which begin between the shoulder blades and pass
through into the chest: raises a stringy, tough sputum when she
expectorates anything, cough being inclined to dryness ; coughs
worse on going to bed and after eating. Cured by Kali bichro-
micum 30 .— G. N. B.
Lungs and Thorax.— Stitching pains, suddenly coming and
going; more apt to be in the right side. "Stitching pains in the
right side commencing in the back and going through the chest,
which are worse at night, when lying down or rising." — H. N.
"Darting stitches in the lungs, and against the sacs of pus
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 191
in the lungs; pains coming on, on lying down." — Noack and
Cough. — Dry, hard, exhausting. Sometimes hard cough
with purulent expectoration mixed with blood and thin mucus; or
hard, round, white masses fly from the mouth when hawking or
Aggravations. — By eating warm food, by exercise, by lying
on the left side (Phos., Lye).
Worse about 3 A.M. Trinks says all the symptoms get regu-
larly worse about 3 o'clock in the morning.
Ameliorations.— Cough better after breakfast.
Accompaniments. — Serous sacking of the eyelids.
Raue gives: "Stitching pains in temples, eyes, ears, teeth and
different parts of the body. After dinner, nausea, faintishness and
sleep ; about noon, chilliness ; at night, heat." Our own verifica-
tions have been in affections of the lower portion of the right
lung, where there was dulness on percussion; stitches with a
cough mostly dry, but an occasional expectoration of bloody
muco-purulent matter; with much difficulty in lying down. In
cases of asthma and hydrothorax, we have regarded the symp-
tom of relief upon leaning the elbows upon the knee, as character-
istic. Kali carbonicum is adapted to ansemic and dropsical con-
stitutions. The cases of consumption most likely to be benefited
by this remedy, are such as have a catarrhal or pneumonic
basis, or when asthmatic, cardiac and dropsical symptoms
complicate the lung symptoms. It is considered better adapted
to that stage of tubercle when the breaking down process has
set in ; when the cough is still exhausting and dry, and hectic
and emaciation are present. It follows Lycopodium to good
advantage and is itself often a leader to Carbo vegetabilis, and
sometimes to Phosphorus.
It is a remedy to be thought of in complications from em-
physema and pleurisy.
Clinical. — Case 1. — "B. D., a girl set. 6, had an attack of
measles which was followed by a severe cough of a dry char-
acter. Stitches and pressing in the chest; breathing short and
oppressed ; the cough was a short teasing one with two or three
paroxysms in rapid succession, usually dry, but with a feeling
192 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
as if some tough mucus was moved about in the trachea which
could not be raised. Eating and drinking increased the cough.
Dulness on percussion in the lower part of the chest, where is
also pain. Kali carbonica 200 cured." — Schelling.
Jahr says: "That under the action of Kali carb. dyspnoea
with violent and irregular beats of the heart disappear, but the
latent tubercles remain the same."
0. W. Smith reports the following : " Expectoration of firm
white globular masses of the size of a pea, flying from the mouth
with considerable force when coughing or hawking; eruption of
minute vesicles on the feet with extensive itching. Burning in
top of head and soles of feet (Sul.). Sweaty paleness; circum-
scribed red spot on one cheek; gastric derangement with belching
tasting like rotten eggs; hungry and faint about 10 a.m. (Sul. 11
a.m.); contraction of the heel cords; trembling sensation through
the entire body, especially through the pelvic region. The 3d
trituration cured where the 200th had failed." (Comparisons
with Sulphur are our own.)
Lungs and Thorax. — Stitches through the sternum to the
back, or deep in the chest while walking.
Cough. — Suffocative cough; cough dry, hawking; later with
copious green sputa, or like soap-suds.
Accompaniments. — Kali hydrojodicum has many symp-
toms similar to Iodium. It has been used successfully in
pneumonia with extensive hepatization, for purulent expectora-
tion, with exhausting night-sweats and loose stool. As in Iodium,
we should regard excessive and rapid emaciation a most import-
ant symptom in the selection of Kali hydrojodicum
Clinical. — Case 1. — " A woman, set.' 30, subject to catarrhal
affections, has had for a period of six months a stubborn cough ;
pain in the chest ; weakness, remarkable emaciation ; fever, with
exacerbation and profuse night-sweat. Physical examination
gives unmistakable evidence of the existence of several cavities
in the upper lung ; breathing is difficult ; the tongue red ; the
hair is falling out. Menstruation has disappeared, and in its
place a stubborn leucorrhcea shows itself. The use of Kali
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 193
hydrojodicum internally, and the inhalation of steam medi-
cated by Iodium, soon brought about a remarkable improve-
The first favorable change showed itself in a freer respira-
tion, and in the cessation of night-sweats, followed by a lessen-
ing of the cough, return of strength, remarkably good appe-
tite, and finally, disappearance of the fluor albus, with which
the patient had been afflicted on a former occasion, and per-
fect recovery. After several years she is now in the best of
health." — Lobethal, in Allg. Horn. Zeitg., XX, 53.
We have no personal experience with this remedy, but find
a valuable clinical report which we give :
Clinical. — Case 1. — " A lady, set. 35, and married, consulted
me for catarrhal phthisis affecting a small space in the upper
right lung, with a crackling respiration, audible even to patient
when recumbent. Expectoration greenish ; dulness on percus-
sion ; paleness ; emaciation ; fever inconsiderable ; cough was
of some month's standing ; patient had taken cod-liver oil ad
nauseam. Prescribed Kali mur. 30 , three times a day, and gave
her freely a preparation made of one-fourth pound of finely cut
suet, simmered in two pints of milk down to one pint, as a
substitute for the oil preparation, simmered in hot water to pre-
vent burning; fat rising on cooling to be skimmed off. Patient
steadily improved for months, when an aggravation of cough
took place which I attributed to my remedy. Gave' remedy
only every third day subsequently. The green color of sputa
soon diminished under treatment, and the crackling sounds
in the bronchi. Ten months from commencement of treat-
ment patient's weight was nearly normal and she was steadily
gaining. Slight dulness, however, remained. Patient appar-
ently cured excepting this. She went to her friends in another
State. She relished her suet and milk well." — J. C. Morgan.
Lungs and Thorax. — Stitches in the left side of chest, with
194 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
dyspnoea and constriction of the chest. Oppressive pain in the
chest as if full of wind.
Cough. — Gagging persistent cough from tickling in the throat"
Violent and long-continued cough from slight pressure on the larynx.
A dry, hacking cough from simply touching the throat. Occa-
sionally a spasmodic cough worse in the evening and at night, with
tickling in the throat. The expectoration is scanty and contin-
ues blood-streaked, usually scanty and difficult to raise. Patient
sometimes coughs in sleep without waking.
Aggravation. — During the day; on failing asleep; from change
of temperature ; after sleep.
Accompaniments. — Larynx and throat painful when touched
and on bending the head backwards; when anything touches the
larynx the latter is not only very sensitive, but there is a sense of
suffocation felt; patient cannot bear clothing to touch the neck.
A majority of the symptoms are felt upon the left side ; this
and the aggravation after sleep are very important. The influ-
ence of this remedy seems to be very pronounced upon the
blood, the pneumogastric nerve and the ganglionic nervous system,
and through them upon the respiratory function producing
hypersesthesia of the tissues about the chest. We have again
and again proved its power to arrest plastic exudations in the
throat when upon the left side; hence we judge it will best
serve us in affections of the left lung.
In acute albuminous affections of the kidneys we have also
found it a very valuable remedy. It is best adapted to the
early stages of tubercular pulmonary diseases, so far as our
own experience goes. It seems especially adapted to the female
Additional accompanying symptoms not mentioned above :
Fever worse in the afternoon; stools smell offensive though nor-
mal in appearance; throbbing in the anus; itching after sleep.
Clinical. — Case 1. — Miss McM., set. 19, of slight build, pale
complexion, thin brown hair and decidedly of the nervous
temperament, had been in declining health for three years;
was now too feeble to ride out except for very short distances;
pale face, or ashy color, with blue veins, soft tissue with a gener-
ally frail and delicate look. Found her troubled with a severe
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 195
cough of rather a dry spasmodic character; worse in the morning
and after lying down, especially after having slept; cough was
also worse whenever there was a change of weather; from her
low state of vitality she was very susceptible to the depressing
influences of cold and dampness; cough often seemed to be
produced by a tickling sensation in the larynx, though the left
lung was the principal seat of the difficulty, where there was
soreness, pain and dulness in upper portion ; menstruation was
quite scanty, pale and delayed about two weeks; some tender-
ness in the hypogastric region. Patient had been steadily
growing weaker for two years and getting worse of her chest
troubles till now her case was pronounced incurable and she
was put upon cod-liver oil, on which we found her. She got
Lachesis 200 , and was kept upon it till cured and no relapse had
occurred ten years later. — G. N. B.
Case 2. — "Miss Emma B., set. 26, was the constant nurse of
her younger sister, who died January 26th, 1871, of tubercular
phthisis; she was not only in the same room day and night
with the patient, but during her illness for about six months
she slept in the same bed with her; slept with her up to the
last night of her sickness. My attention was called to Miss
Emma June 9th, 1879; she had been coughing for more than
two months; the cough was frequent, dry, short and sharp or
harsh in sound; she is tall, of slender form, prominent clavicles
and now considerably emaciated; she has light brown hair
and blue eyes; there was loss of appetite and strength; great
flow of spirits and a constant affirmation that she felt no pain,
was not at all sick ; pulse 96, small. On the 24th, an exam-
ination three times repeated because of her assurances that
there was nothing the matter, established the fact beyond all
doubt that no air entered the posterior superior half of the left lung,
i. e., no respiratory murmurs could be heard in this part of the
chest, though well enough heard in the corresponding portion
of the right lung ; taking into account the family tubercular
taint, the constant contact for six months with the sister dying
of tuberculosis, the emaciation, loss of strength, frequent pulse,
the character of the cough, its persistent continuance, the pe-
culiar disposition of mind, I could not but conclude that there
196 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
was tubercular infiltration of the part affected ; though there
could be no certainty of the truth of this conclusion, the prob-
ability to say the least of its correctness is very great. Re-
garding Lachesis as having more points of resemblance to our
case than any other remedy, I dissolved six pellets of the 200th
of this remedy in a half tumbler of water and directed patient
to take a teaspoonful night and morning for six days ; eleven
days after the state of the lung was carefully examined and
the respiratory sound was heard in that part of the lung where
at first examination it was absent; a subsequent re-examina-
tion showed that the lung was clear of obstruction." — P. P.
The two cases show a left-sided affection and a violent, some-
what spasmodic, cough, dry in character. The impression of
Lachesis is very profound upon the nervous system, is pro-
ductive of plastic exudations and most of the symptoms are
left-sided. The cachexia is a blood cachexia with glandular-
excitement and adventitious loading down with nitro-carbons.
Case 3. — A young man of phthisicky habit who had pneu-
monia treated by bleeding, has been failing for six months,
is greatly emaciated and has a constant cough. Symptoms:
short, superficial hacking cough, very exhausting, sometimes result-
ing in vomiting; expectoration is very difficult, scanty, either thin
tough mucus or thick, round, small lumps which fly in different
directions (Kali carb.) ; quite often he coughs, hacks and spits all
at once without being able to raise anything; he coughs only during
the day (characteristic of Lachesis, as is cough during sleep,-
but he is not conscious of the latter). The cough is aggravated
from walking in the open air, also from talking, which seems to
cause a sensation of dryness and consequent inclination to cough ;
worse also after damp weather and eating fish; it often seems as
if the cough started in the pit of the stomach, where it tickles
and is so painful during a hard coughing spell that he is
obliged to press against something (Phos.); during the cough
there is an ulcerative pain under the ribs and in the trachea,
also accumulation of water in the mouth; shortness of breath,
especially after exercising with the arms ; stiffness and weakness
in the knees when rising ; weakness obliges him to stoop when
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 107
walking. In the forenoon nausea, loss of appetite. Gave
Sepia; the first dose was followed by improvement which con-
tinued for three weeks, after the second dose he grew worse;
the characteristic symptoms, especially aggravation of the
cough after sleep pointed to Lachesis; one hour after taking
Lachesis the cough became worse, he expectorated some yellow
matter, after that the cough became looser, easier, less frequent;
after several doses the symptoms had almost wholly disap-
peared and eventually he felt well and strong.'' — Hering in
Archiv., XV, 1, 56.
Lungs and Thorax. — Continuous pressure on the chest, raw
feeling internally. Paralysis of the lungs. Neglected pneumo-
nia, with continuing hepatization.
Cough. — Dry, day and night, fatiguing ; affects stomach and
head. Sputa gray or grayish-yellow, more rarely yellow, and
Aggravations. — From 4 to 8 P.M.; on alternate days; from
stretching the arms out; from stooping and lying down; in wind,
or in a warm room.
Accompaniments. — Chill from 4 to 8 P.M., with numb hands
and feet, icy cold at 7 P.M. Sour vomiting between chill snd heat;
flushes of heat over the whole body, toward evening; with frequent
drinking of small quantities at a time (Ars.) ; with increased mic-
turition. Sweats from least exertion (Merc). Heat, with inclina-
tion to uncover.
Lycopodium has a powerful influence upon plastic exuda-
tions on the right side (reverse of Lachesis). It acts in a most
efficient manner to remove excreta through the kidneys, and in
a somewhat pronounced manner also through the alimentary
tract and skin. As a solvent to albuminoids our observations
have been extensive in regard to diphtheroid affections com-
mencing upon the right side; many symptoms travel from right
to left. It seems pretty well settled that in pneumonia passing
into hepatization, and for the suppurative stage of hepatization, Ly-
copodium is a decided remedy; and further, evidence tends to
show that in tubercular affections allied with pneumonia, and in
198 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
cases of hemoptysis followed by purulent expectoration, whether
from tubercle or otherwise, Lvcopodium may be expected to
ameliorate the symptoms, and postpone fatality indefinitely.
To what extent it shall prove sufficient to eradicate the tuber-
cular diathesis, and remove the tubercle from the lung, may
be regarded for the present as an open question ; but it cer-
tainly is a remedy to be most carefully studied, as many of our
fatal cases of pulmonary disease come from old catarrhs and
badly managed pneumonias.
In chronic catarrhal affections Lycopodium has for a long
time held almost the foremost place. Hitchman reports a case
of pneumonia supervening upon tubercular deposit, accompa-
nied with pleurisy and serous effusions, cured by Lycopodium.
" There was diminished resonance and mobility of chest with
flattening; tubular breathing and cavernous sounds; pulse inter-
mittent and small; voice weak; cough severe day and night,
with profuse expectoration ; hectic fever and night sweats ac-
companied ; and the hand on the suffering side cold and emaciated
was used to indicate his wants."
Dr. Pope says : " Few medicines are so valuable in pulmon-
ary phthisis as this when persistently used; the cough, gastric
irritation, exhaustion and intercurrent attacks of pleurisy, are
wonderfully mitigated by it." .
Raue verified it in "a case with expectoration of large quan-
tities of pus; cough day and night; hectic fever; circum-
scribed redness of the cheeks."
Burt recommends it for subacute and gradually advancing
chronic cases, and for people with sallow complexion and cold
Clinical. — Case 1. — " W. M., a boy, set. 14, very feeble and
always remarkably thin, of very weak muscular development,
but of sensitive mind and excellent intellect, whose mother
had died of consumption, has the following symptoms; hard
dry cough all day and night; coughs also in his sleep; then
violent dry cough in the morning; great emaciation; is so fee-
ble that he can hardly stand; no secretion of mucus from the
lungs; respiration, and pulsation of heart very rapid; but aus-
cultation and percussion elicit no signs of decided disease of
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 199
lungs; appetite voracious. Administered Lycopodium 200 , two
closes. Cough was rapidly cured, and boy soon well as usual."
— C. Wesselhoeft.
Case 2. — Miss Jennie Y., set. 15, with blue eyes, fair
complexion and light hair, very forward in her studies and
with quite a genius for music, very nervous and easily ex-
cited, has suffered considerable from malarial influences; been
troubled with a dry cough more or less for two or three years;
was poorly all winter, and finally early in March was taken
down with chills, to which was added an aggravating cough
and hectic fever. Left lung very sore all over the region above
the mammse, so sore that percussion is hardly tolerated; dull
sounds show condensation, and the bronchial murmur is quite
too distinct; fever was almost continuous, with a perceptible
aggravation in the afternoon and evening; chill at 7 p.m. quite
regularly with night sweats, which were sour; chill begins on
left side of body ; thirst during chill and a little before; constipa-
tion; no appetite; pulse 120; sometimes vomits a little, which
is sour. Patient was treated by myself and by my colleague
at times for three months with no improvement, but on the
contrary, with a steady loss of strength and flesh ; nothing did
her any good till Lycopodium 200 was given, when her chills
yielded for the most part, and quite an abatement of the fever
followed ; she still coughed badly and rallied but slowly until
she was given Tuberculinum, C. M., Swan, after which she
mended rapidly, beginning to eat pork, which she craved, and
some vegetables; chicken and lamb were added to her diet
also; cream in wine and malt in beer she used freely. As I
shall speak of the case again under Tuberculinum, I refer the
reader to that remedy for the further history of the case. —
G. N. B.
These cases with the one I have reported in chapter on
hemoptysis, lead us up pretty clearly to the tubercular dys-
crasia and tubercular deposit, and shows that there is good
reason for believing that Lycopodium should be classed
among our remedies capable of modifying the coarse of a
phthisis, and indefinitely postponing the suppurative crisis and
possibly of radically arresting the course of a caseous exuda-
tion having its origin in a scrofulous cachexia.
200 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
C. C. Smith writes me that he has found Lycopodium "espe-
cially useful in dry coughs, day and night, in feeble emaciated
boys. Chill every seventh day."
Raue mentions that patient does not like to be covered.
Case 3. — Mrs. C. H., set. 27, of a sanguine bilious tempera-
ment, was taken with cough and blood-spitting about one year
ago while keeping school, but did not leave her work. Coughed
violently, raising but very little. Second attack of blood-spit-
ting the following January. Lungs felt sore from coughing.
Three months later began to expectorate and has continued to
do so till the present time, and now raises very freely a green-
ish muco-purulent matter with putrid taste. Cough is worse
night and morning, though she usually wakes once or twice in
the night and coughs. Night-sweats set in soon after second
hemoptysis. Menstruated till the 1st of September ; has seen
nothing since (five months). Chills and fever more marked
at that time than before or since. Chill appeared in the after-
noon, and fever lasted till late in the evening. Night-sweats of
a sour musty odor staining the undergarments yellow. Sweating
stage usually the last of the night. Has steadily lost flesh from
the first; appetite poor, hardly able to eat at all. Feet and
hands cold. Complains that her lung smarts and is sore, more
particularly at the third rib upon the left side and midway
between the sternum and shoulder-joint; has at times a pain
which seems to go back to the shoulder-blade (Myrtus, Sul.).
Percussion reveals dulness over a large part of the left apex,
and auscultation gives us broncophony and heavy rales as if
from a cavity. Voice also resounds from the chest. Feet bloat
in the daytime; hands and feet sometimes numb. Has ob-
served at times a reddish-brown sediment deposited from the
urine. Cannot lie upon the left side. Gave Lycopodium 200 , one
dose, and put her upon cream and milk a pint a day divided
into three parts, to which she adds a teaspoonful of brandy on
taking ; ordered malt with her food.
Improvement of fever and night-sweats; a trifle better of
cough four days later. Repeated the dose. Six days later
slightly improving, but says she is sleepy all day, and when she
coughs she puts her hand upon the pit of the stomach to relieve the
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 201
pain and bad feeling. Always coughs if she turns upon the left
side, Gave Phosphorus 200 , one dose. Patient steadily mended,
though very slowly, for two or three weeks, meantime making
a visit of a week to her home in the country. Returned, say-
ing she was feeling better generally; was stronger, did not
cough as much, but had soreness of the throat on the right
side which was aggravated by her cough.
Gave Lycopodium 10m (Fincke); continued to improve for
one week when she caught cold, and had an inflammatory
attack upon the right lung attended with an aggravation of
cough, soreness and stitching pains through to shoulder-blade.
Gave Bryonia 200 ; cough and pains soon better; continue Bry-
onia and let her go to her friends in the country. Talked a
good deal and from the excitement had another attack of
hemoptysis. Sent her Aconite which she took twice a day
and returned not appearing the worse for her hemorrhage.
Cavity in lung less loaded with purulent secretions as evi-
denced by the rales and amount expectorated. Dulness yet
remaining over the upper third of left lung. Gave Sulphur 10 " 1 ,
one dose, being guided thereto by growing dryness of cough,
soreness of chest in region of third rib, with a sore feeling
seeming to go deep back toward the scapula. Ten days later
patient complained of having taken cold and getting a sore-
ness low down in the right chest- walls, or over the superior
portions of the liver. Pain stitching in character. Gave Kali
carbonica 200 , a single dose.
Reports better two days later and goes to the country again.
Subsequent two months patient took a dose of Lycopodium
once a week and continued to mend slowly. This case is
under treatment and final result cannot be reported, but there
is fair prospect for recovery judging by present symptoms. —
G. N. B.
This case is not so valuable as a clinical verification, because
of complications seeming to call for other remedies, still the
author trusts it is not altogether wanting in suggestiveness.
Putting the cases reported under hemoptysis and chronic pneu-
monia with the above, I think Lycopodium is shown to hold a
high rank among remedies which may be successfully relied
202 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
on to modify the'course of a consumption, and perhaps control
the dyscrasia out of which it has developed.
Lungs and Thorax. — Stitches in the left chest during in-
spiration and between inspirations. Stitch in the anterior supe-
rior portion of the chest extending through to the back, when cough-
Cough. — Violent racking cough every other evening; cough
w r ith pain in the chest and small of the back. Severe, dry cough,
or cough with bloody sputum in tuberculosis. Short dry cough
excited by tickling in upper anterior walls of the chest, very
fatiguing and hardly allowing one to speak. Violent night cough.
Aggravations. — Night air; dampness.
Accompaniments. — Shortness of breath as if one had in-
spired smoke ; shortness of breath on going up-stairs, and on
walking, as if one could not take in sufficient air. Chill more
generally in the evening after lying down, not relieved by
warmth of the fire; internal chill with heat of the face; heat with
sensation of pressing together of the chest, anxious; heat with
aversion to uncover.
Often there is an inclination to vomit during coughing.
Sometimes we have hoarseness and aphonia.
Mercurius has proved curative in suppuration of the lungs
after hemoptysis, in tuberculosis with bloody sputum, also in
abscesses following pneumonic hepatization. It is thought to
act more decidedly upon the lower portion of the right lung
(Hering). Headland affirms that Mercury has the power to
deprive the blood of one-third of its fibrin, one-seventh of its al-
bumen, one-third or more of its globules, and at the same time
loads it with fatty matter. The tendency of the morbific force
of phthisis to transform albumen into fatty matter presents an
analogy of action, strengthening, as it would seem, the homoeo-
pathic indication. We have often noticed the facility which
patients having phthisis pulmonalis had for taking on albu-
minuria. A few years ago this species of nephritis was con-
sidered an incurable disease; now it is known to be amenable
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 203
to remedies; especially have Apiurn virus and Mercurius
proved very efficacious.
Mercurius has a long-time reputation for curing catarrhal
affections, especially when induced by cool evening air; also
for syphilitic affections which have suggestive analogies in
We bring Mercurius forward as an ally to Apium virus,
hoping that it may prove a remedy to abort or arrest the exu-
dative stage of phthisis pulmonalis, in many instances.
We suggest the higher potencies as the ones more likely to
be beneficial in incipient phthisis.
Clinical. — Case 1. — "A childless woman, set. 36, had pneu-
monia two years ago; since then, after nursing a hectic hus-
band, she has had all the symptoms of incipient consumption;
she has been under allopathic treatment without receiving any
benefit. Symptoms: internal soreness in the throat from the
cough, with burning in the pharynx; the tonsils and uvula
soft; gums red and swollen; swelling of the cervical glands;
feeling during deglutition as if a plug were in the throat;
hoarseness and roughness of the voice; burning and tickling
in the throat; provoking cough; stools hard, in small pieces,
pressed together; haemorrhoids, with occasional hemorrhage,
followed by relief. Menstruation has been absent eight weeks.
The cough is dry, tickling; slight expectoration of phlegm
after three or four coughs, lightest during the day, increased
before going to sleep and right after awakening, but hardest
in the night between 12 and 2 o'clock. Frequent and difficult
respiration, especially when going up-stairs, with stitches below
the right floating ribs toward the back, running up as far as
the place between the shoulder-blades, aggravated by cough.
She cannot lie on the right side; feels best in the morning;
flashes of heat alternating with coldness; worse in the after-
noon, best when warm and quiet; stubborn. Gave Merc, sol. 1 ,
followed by aggravation until the seventh day ; then gradual
improvement, followed by recovery. Menstruation never re-
turned." — Loescher in Archiv, III, 1, 74.
204 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Lungs and Thorax. — Acute pains in the chest and pressing
pains in chest. Pains in chest and throat with blood-spitting;
also dryness of the throat. Stitches in the left breast, running
through to the shoulder-blade, as they often occur in tuberculosis.
Relieves where no other remedy could.
Hepatization of the left lobe of the lung.
Cough. — Dry hollow cough from tickling in the upper anterior
lobes of the lungs, worse in the morning, less tickling in the evening
Cough with tightness of the breast.
Pehrson gives the symptom: "Cough with tickling in the
Accompaniments. — Pains in the joints, stomach, chest, and
throat. Catarrhal fever with pain in the elbows and knee-joints.
Great lassitude during the afternoon hours.
Paue in Pathology and Diagnostics, page 183, mentions for
indications in pulmonary phthisis : " Stitching pains in the left
chest, from the upper portion straight through to the left shoulder-
blade, worse from breathing, yawning and coughing."
The myrtle has been introduced to our notice by the Ger-
man physicians as a valuable remedy in pulmonary phthisis,
and from recent observations made by Wahle it is fair to pre-
sume it is to take rank among our very best agents, such as
Sulphur and Phosphorus. Dr. Hering says if we wish to pro-
vide ourselves with the remedy, "Take a bunch of the myrtle
as it is everywhere cultivated in pots, put it in a bottle with
alcohol, and in a few days the tincture will be ready to form
the attenuations." It is said that some of our physicians in
Philadelphia have used Myrtus in the 3d dilution with great
Dr. C. C. Smith sends the following symptoms: "Stitching
pain in left chest from upper portion straight through to scapula,
worse on deep breathing, or when coughing," also, "burning pain
in left chest, with throbbing, aching and tickling."
Dr. Wm. E. Payne reports in the Halinemannian Monthly,
Vol. VI, p. 356, a case of pulmonary tuberculosis in which the
symptoms were greatly improved by Myrtus, and gave as
leading indications for its use : " Throbbing ache and stitching
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 205
pain in the left infra-clavicular region, extending thence through
to the shoulder-blade, aggravated by making a deep inspiration.
Sensation of burning in left chest."
Most of the above symptoms are from Wahle.
Lungs and Thorax. — Sensation and pain in the chest as
from tension. Vague pains in the thorax.
Cough. — Cough seems to come from a tickling sensation in
the throat, or pit of the stomach. Cough with sputum of bloody
mucus ; or yellow blood-streaked matter.
Aggravations. — Worse from rapid motion; from deep breath-
ing; from lying down in bed and becoming warm.
Accompaniments. — Weak voice; easily gives out from talk-
ing (Stan.) ; morning accumulations of mucus in the trachea and
larynx. Anxious oppressed breathing which is ameliorated
by exercising the arms, and going into the open air. Stitches in
the sides; bursting pain in the forehead; shocks or beating con-
cussions in the head. Involuntary micturition (Caust, Phosph.).
Stitches in the liver. Craving for salt. Chill at 10 A. M. Chlorotic
appearance of face; palpitations which are worse from lying
upon the left side. Great dryness of the mouth. Patients get
worse at seashore.
From our success of late in removing malarial cachexia with
Natrum mur., we expect it will be found adapted to a class of
pulmonary diseases where the malarial element is an import-
Lungs and Thorax. — Soreness and constriction of the chest.
Stitches in right side of chest and in trachea which feels as if a
sliver was there. Cramp-like pains in chest. Soreness in chest
as if ulcerated.
Cough. — Dry, barking, from tickling in larynx and pit of
stomach. Sputum is raised with difficulty; is sour, offensive,
bitter, being yellowish and muco-purulent. Greenish-white casts,
as if from air-cells.
206 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Aggravations. — In the evening and when lying down.
Accompaniments. — A characteristic sensation is pricking
as from splinters; this is often felt in the throat. Loss of
breath and speech from weakness (Stannum). Panting during
work. Sensation of great weakness felt early in the morning,
and sometimes in the afternoon. There is weariness and
trembling throughout the body; chilliness on the back upon
getting into bed; fugitive flashes of heat, usually in the cheeks
or hands, unattended by thirst. Can endure but little covering.
Pains get worse toward evening, especially the drawing pains.
Dr. Dunham gives: Sticking pains in the rectum when coughing.
Sometimes patients have extremely strong and offensive urine; these
indications will be supported if there are hemorrhoidal tumors,
fissures, or anal eruptions.
It is characteristic of Nitric acid that the pains are not well
In grouping together the symptoms of this remedy we find
many analogous to those attending the development and pro-
gress of phthisis, particularly that variety of phthisis having
its origin in syphilitic or mercurial poison.
There are clinical verifications of its having cured cases
where there was purulent expectoration accompanied with rat-
tling in the trachea and nausea.
Lungs and Thorax. — The action of Phosphorus is most
marked upon the lower and middle lobes of the lungs. Guiding
symptoms for its use are: great tightness across the chest. Con-
gestion to the chest worse from any emotion. Burning and pierc-
ing soreness in the chest. Pain in chest from coughing relieved
by pressure upon the external walls.
Cough. — Dry, tickling, with tightness across the chest. Cough
provoked by soreness and tickling in the larynx. Hollow, nervous,
spasmodic cough. Harsh, irritating cough, with muco-purulent ex-
pectoration, or bloody muco-purulent expectoration, Cough which
shakes the whole body. Cough provoked by a sticking sensation
in the epigastrium, relieved by pressure. Cough with pain going
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 207
from pit of stomach through to spine. Cough with stitches over
one eye, with a splitting headache. Cough with hoarseness and
Aggravations. — When one enters the room ; from strong odors ;
before a thunder-storm. Worse evening and just before midnight.
When going from warm into cold air; from laughing, talking,
eating, drinking ; from lying on left side or back.
Ameliorations. — After sleeping (reverse Lach.) ; from lying
on right side; from cold drinks.
Accompaniments. — Goneness in region of the stomach ;
painless diarrhoea, or long narrow difficult stool; puffiness
around the eyes; bursting headache occasioned by coughing;
apthous patches on roof of mouth or tongue. There is an in-
clination to yawn; there is a free flow of watery urine when
afflicted with pain; perhaps involuntary micturition when
coughing. There is often loss of hair in spots. Night-sweats
come on during sleep, and are clammy, more upon the head, hands,
and feet. Chill without thirst, generally in the evening; chill
alternates with heat.
The disposition is irritable; mind over-active, and body pros-
trated from the least unpleasant impression. The mind is by
turns gloomy, mirthful, anxious or indifferent, but excitability
is the rule. There is thirst, with a desire for something refresh-
ing, and a great relish for cold milk, ice cream, etc. Phosphorus
agrees with the hemorrhagic diathesis, and with blood-spots in
the sputum or the discharges from the nose.
We see the feebleness of the nerve-work or structure-control-
ing power, the brilliancy of the mental faculties, the increased
amatory excitement, attended with a steady emaciation, in
our Phosphorus type. It agrees with the tall, lean and florid
temperament, very different from the chubby, fat and lym-
phatic temperament of Kali bichromicum, or the petite figure
with chalky face, of the Calcarea temperament.
Phosphorus is well adapted to slender or rapidly growing
persons, to persons subject to hemoptysis, or to frequent bron-
chial attacks with great debility ; also to those cases of tuber-
culosis where there is a complication of fatty degeneration of the
208 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Those who believe tubercular diseases to be incurable, and
but indifferently amenable to palliation even, will probably
continue to doubt whether our cases reported as tubercular
phthisis and cured by Phosphorus, were anything worse than
cases of obscure pneumonia, after all.
That Phosphorus is best adapted to those cases which most
simulate pneumonia, or have tubercular deposit, provoked by
old inflammations of the lungs, we are inclined to believe.
Tubercular affections are not uniformly the same in totality,
and the concomitants of tubercle are very important factors
in selecting a remedy.
The notoriety gained in certain quarters from the use of
phosphate of lime and phosphate of soda in phthisis, goes to
corroborate the testimony of physicians who report cures from
Phosphorus, as Phosphorus is conceded to be the chief modify-
ing agent in such cases; Phosphorus the great nerve-corrector,
and lime the nutrient modifier, supplying all the curative ele-
ments in the case.
The types of constitution to which the phosphate of lime
promises best results are : the nervous, scrofulous and rachitic-
scrofulous, as seen in the caries of the bones, and tubercle with
hemorrhagic tendencies, and tubercle with pneumonic and
pleuritic complications, attended with great mental activity.
Clinical. — Case 1. — " G. E., set. 34, machinist, temperate, with
no hereditary predisposition to phthisis ; took cold four months
ago ; found evidences of a left-sided pleuritis, with exudative
products unabsorbed ; patient was emaciated ; chest contracted ;
was without appetite and very weak, with tendency to diar-
rhoea ; profuse night-sweats, and suffering from a continuous
cough, worse in the morning, at which time there was copious
purulent expectoration. Physical signs point to acquired
tuberculosis of the left lung, there being a spot, size of the
hand, dull on percussion, with hardly audible murmur, accom-
panied with bronchial sounds more pronounced, and at another
point cavernous rales and tympanitis; fever marked. Patient
was put upon Phos. every other evening ; in six weeks cough
and expectoration had much improved ; less dulness, rale
more dry." — Lorbacher.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 209
Case 2. — "P. S., set. 31, working in factory; lost father and
one brother from tubercular affection of the lungs; suffered
for the last four years with occasional hemoptysis ; short, dry
cough and difficulty of breathing. Consulted me after a pro-
fuse hemorrhage. Aconite and Bryonia had been taken. Pa-
tient was a small, somewhat emaciated person, with flattened
walls of the chest anteriorly; defective expansion during in-
spiration ; dulness on percussion and abnormal murmur; bad
dyspnoea on ascending the stairs, and a dry cough through the
day and evening; expectoration towards morning, with pus;
granules in the mucus, and night-sweats. Gave Phosphorus 30 ,
a dose every other evening for one month ; then repeated at
longer intervals for a year or more ; disease three months later
had so far improved as to admit of patient attending regularly
to his labor. One year later a slight hemoptysis, which was
easily controlled, but no progress of tubercular degeneration
or deposition." — Dr. Lorbacher.
Dr. Lorbacher like many others has found the more ad-
vanced potencies better modifiers than the lower potencies.
Our arrangement of clinical cases is somewhat arbitrary,
growing out of our classifying phthisis under different heads.
For a more extensive study of clinical cases the reader is re-
ferred to our chapter on Caseous Pneumonia, or Pneumonia
with Cheesy Exudation.
Lungs and. Thorax. — Pains in chest coming by fits, with
great anxiety. Feeling as if there were an ulcer under sternum.
Pain in the right hypochondrium when coughing. Chest inflates
only with much exertion.
Cough. — Dry cough, with shortness of breath, provoked by
a tickling in the trachea ; coughs a long time before beginning to
expectorate (Alum.). Sputa of green mucus.
Aggravations. — From talking and from drinking.
Accompaniments. — Sensation as if the throat were con-
stricted, and has to cough to relieve the sensation. Dyspnoea,
which is better in a recumbent posture, and worse from sitting up,
and when the arms are brought near the body. Pain in right side
210 PHTHISIS PULMONALIS: TUBERCULAR THTHISIS.
worse from coughing; palpitation of the heart. Bodily excre-
tions and exhalations have an offensive odor. Profuse sweats,
and sweats from the least exertion at night, with great weakness.
Feels restless before a thunder-storm. Bloody discharges from the
rectum. Breath offensive ; odor like rotten eggs ; flatulence pass-
ing the bowels which smells like sulphur.
Clinical. — Case 1. — "Mrs. C. R., aet. 46, emaciated, hectic,
exhausted ; cough loose, racking, spasmodic; expectoration copious,
offensive, bloody, chiefly at night; violent, craving hunger, and
sinking, gone sensation; craves hearty food, coffee, acids; dis-
tress and unrest from flatus ; constipation ; copious, offensive leu-
corrhea; pressure in vertex.
" Fine gold-like threads before eyes ; dark illusions ; heavy sen-
sation in right temple toward the right eye. Thirteen years ago
the itch was suppressed by ointments ; the scalp itches occa-
sionally without eruption. Psorinum 200 at the suggestion of
Wm. P. Wesselhoeft brought out an eruption between the fin-
gers ten days after, which itched violently, and cured the case."
— C. F. Nichols, M.D.
Case 2. — "A gentleman, set. 26, who had grown rapidly, of
unmistakable consumptive habit, with bad family history.
When a child had itch cured with unguents. In his nineteenth
year had bleeding from the lungs, since then every year. Symp-
toms : for eight years he has had occasional night-sweats ; fre-
quently hoarseness, especially early in the morning. Cough at
times dry, again with expectoration tasting like old cheese. It
is hard for him to climb stairs, although he usually feels best
while in motion. The right clavicular region and the infra-clavi-
cular fossa yields a dull sound upon percussion.
"Auscultation of the left and more particularly of the right
anterior thorax, showed that inspiration was short and super-
ficial, while expiration was comparatively deep. Gave Psori-
num 5 , one dose daily ; after four weeks gain in flesh, increased
activity, general improvement of every symptom ; appearance
of an itch-like rash. Percussion sounds unchanged." — Leid-
beck in Hygea, XIII, p. 579.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 211
Lungs and Thorax. — Oppression of the chest with pressure
on stomach. Suffocative attacks after midnight, with throwing
abont of the arms and shedding of tears ; patient has to sit up in
bed to get breath.
Cough. — Cough spasmodic, hollow and dry ; very tormenting.
Expectoration of small quantities of tough, yellow mucus, only
during the day ; sometimes copious mucus, yellow and of saltish
Aggravations. — At about midnight; from head lying low;
from dry, cold air.
Accompaniments. — (Edematous swelling of the feet and legs.
Hands and forearms bloated, and blue. Renal and cardiac disturb-
Paue gives : " Profuse sweats, but only when awake ; the skin
becoming dry and hot during sleep."
Hering mentions that "In Sambucus cases, inhalation is reg-
ular, but sighing attends exhalation."
C. C. Smith sends : " Patients can inspire, but expiration is
We have met a class of cases in phthisical families where
there seemed to be early tendencies to dropsical complications.
Such have looked sallow in the face, and bloated about the face
and limbs. We remember in particular the case of a woman
past 40, whose children had all died of phthisis, who herself
showed marked tendencies to dropsical complications and really
broke down more from troubles affecting the heart and liver
than the pulmonary structures.
The following are typical cases:
Clinical. — Case 1. — " Woman, set. 32, constant cough, copious
expectoration of salty taste; loss of strength; increasing dysp-
noea; cough with pain in chest; legs cedematous as far as above
the knee. *
March 26th, she received tinct. cort. Sambucus nigra, one
dose each day.
I saw the patient after six days and had every reason to be
pleased. The constant cough had been easier, the arterial
excitement was less, a four hours sleep had given her new
212 PHTHISIS PULMONALIS: TUBEKCULAP PHTHISIS.
courage and the OBdema had descended below the knee. The
patient said the remedy had acted especially upon the urine
and skin, for she had been obliged to urinate three or four
times each night and there had been an itching all over, which
she had never before had. The remedy was repeated every
other morning, — improvement progressed daity, the oedema
grew less and less, and could hardly be noticed in the morn-
ing; cough and expectoration became more rare and the dysp-
noea lessened as she grew stronger; the urine which under the
action of the first six powders had deposited a copious fetid
sediment, commenced to look clearer; in spite of the stubborn
itching, no rash showed itself, but the epidermis scaled off with
violent itching. May 12th, I found the convalescent busy
about her home duties." — Schueler in Arch. XIV., 3, 34.
Case 2. — "Male, set. 20, of strong constitution. After drink-
ing of cold water, inflammation and fever, violent cough and
expectoration; after several remedies had been given without
affording him relief, he was in the following condition : press-
ing pain in the chest; cough torments him day and night, with
copious expectoration of nasty, sweetish taste; pale, earthy ap-
pearance of countenance; emaciation; rapid, weak pulse; burn-
ing heat in the palms of the hands ; much thirst in the P. M. ; pro-
fuse night sweat; tongue lightly coated; bowels regular; appe-
tite, which at first had been good, is now quite gone. Gave
tinct. cast. Samb., one drop, 3 times a day. After the first two
doses relief; cough and expectoration were far better; appetite;
after 14 days the pain in the chest and the sweats had left him.
A perfect cure followed." — Schulz, Pr. Beitr. II, 185.
Lungs and Thorax. — Pain in the right chest to shoulder
(Kali bichrom., left, Myrtus, Sulphur), affecting the muscles so
the arm is raised with difficulty to vertex. Heat in right chest
passing down to stomach and perhaps to abdomen. Great sore-
ness in chest from coughing. Burning in chest.
Cough. — Cough dry, often excited from a constant tickling
at entrance of larynx, also from tickling in stomach, and from a
crawling sensation behind the sternum. Cough often awakens one
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 213
at night and compels the erect posture, and ceases on the passing
of flatus upward or downward. Sputa bad-smelling, noticed even
by the patient.
Accompaniments. — Flushes of heat passing over the body, or
heat flying from head to stomach, or chest to stomach, are very
characteristic of Sanguinaria. The fever is most apt to appear
at 2 or 3 o'clock, P.M. daily, and with circumscribed redness of the
cheeks; this redness simulates peculiarly that which is almost
always present at some stage of a pulmonary phthisis. Pulse
quick and small ; hands and feet burning ; breath short ; heat
after coughing spell; yawning; belching of wind, and passing of
flatus from the bowels; night-sweats and diarrhoea. There is an
empty feeling in the stomach, which eating aggravates rather
than relieves. Patient dislikes motion. Some authors think
Sanguinaria controls the heart's action as does Digitalis; our
provers speak of frequent palpitations before vomiting, with a
sense of great weakness.
We are convinced from experience that this remedy has not
received the attention from the profession which it deserves.
We were cured with it ourself of a very teasing and debilitat-
ing cough which had lasted four or five weeks, and had with-
stood other remedies. There was much tenderness in left chest
under third rib, with soreness, burning and smarting worse when
we coughed. Cough was dry, voice weak, with a feeling of gen-
eral prostration and weakness, as with a slow fever. It is to be
noted that the trouble was in the left lung in our own case,
while a majority of provers say the action of Sanguinaria is
chiefly upon the right lung.
Dr. Hoi combe speaks of it for a harassing cough with marked
inflammatory action, where you are uncertain whether you are
dealing with a chronic bronchitis or an incipient tuberculosis.
Dr. C. C. Smith speaks of it as a remedy in syphilitic affec-
tions of the lungs. He also sends the symptom : " Desire to
take deep breaths, followed by intense pain in right side of chest,
and morning lassitude."
Clinical. — Case 1. — "M. has coughed more or less for years,
but more during the summer ; a year ago he had pneumonia,
after which his cough sounded suspicious; he cannot lie down
214 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
but sics up ; his countenance is bloated, his pupils somewhat
enlarged, his pulse small and quick ; night-sweats, diarrhoea,
pain in the legs, pain in the chest, every attempt to breathe is
accompanied with a murmur (rauschen) in the chest, followed
by cough ; otherwise the cough comes in paroxysms of very copi-
ous expectoration of fetid pus ; the breath also is very fetid (Psor.)
and disagreeable even to the patient. Choking with the cough ;
before and after coughing, spasmodic hiccough; with the cough a
beating, and feeling of tightness in the head. After cough heat
continues some time ; after the heat, yawning and stretching.
" Gave Sanguinaria 3 , one dose evey two days ; after this con-
" The fetor of breath and expectoration disappeared alto-
gether. Lessening of the expectoration, which a few days ago
were streaked with blood ; he can lie horizontal once more
and walk about during the day." — Hempel and Arndt's Mat.
Med. from Bute in N. Arch. II., p. 148.
Lungs and Thorax. — Oppression of the chest and shortness of
breath from exercise. Stitch in left chest and scapula when
breathing or coughing ; soreness in the sternal region of the
chest ; congestion of blood to chest.
Cough. — Dry cough at night until midnight, accompanied fre-
quently with nausea and vomiting of bitter substances ; coughs
till breath is gone and then gags or vomits. Coughs through
the evening, only stopping when the cough loosens, so as to expec-
torate a little phlegm; cough with blood-streaked expectoration
after dinner ; expectoration in the morning of green or gray puru-
lent matter, generally of a saltish taste ; sometimes the taste is
putrid and the breath fetid. (Psor., Sang.)
Aggravations. — When at rest; when lying on left side
(Natr. mur., Phos., Lycop.) ; from use of acids.
Accompaniments. — Palpitation ; fatigued badly by a short
walk. Face pale and sallow with pimples, particularly upon
forehead and tip of nose. Falling off of hair ; disposition to take
cold from dry, cold winds, and from getting the head wet. Night-
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 215
sweats ; sweats most upon the back and thighs, moving downward
upon the calves ; sweat smells sour or offensive; urine also offensive.
Clinical.— Case 1.— "Miss M. J. H., set. 28, dark brunette,
sisters died of consumption ; has had affection of the lungs
with hemoptysis and cough for six years ; often troubles her
now when she is obliged to exert herself as a nurse, but the
cough is less since the appearance in the face of a red papular
eruption, now existing for two years ; it consists of a hard papula
on a red base without suppuration, on her cheeks, forehead, nose
and chin ; characterized by burning, itching and smarting, espe-
cially in wet, cold weather ; menses too often and too profuse.
Lung troubles were : a dry, hard cough most of the time, with
slight expectoration on rising in the morning; much desire to
clear the throat of phlegm which cannot be raised ; has an op-
pressed feeling through the lungs after a hard fit of coughing;
says her cough seems to come from her stomach, which feels
as if scraped. Sepia 200 , two doses, removed all symptoms per-
taining to the chest, and for a long time, and we know not but
to the present." — C. Wesselhoept.
This may be studied with Dr. Hitchman's case, reported
Case 2. — " A man of forty years, small and phthisicky, had
been bedridden with consumption for six months. During
December he received Phosphorus with good results, then Cal-
carea 12 , then Lycopodium 12 , with improvement until the middle
of April, when he had come to a standstill, he received Sepia 30 ;
after this there was a constant improvement in the lung until
the end of May ; the patient could lie equally well on the back
and on the sides and was no more troubled with night cough,
nor did he cough much during the day ; the expectoration had
lost the appearance of pus and showed only white bronchial
mucus ; there was such a wonderful improvement in his con-
dition, that no one would have recognized in him the formerly
hopeless case; he resumed his occupation as shepherd and
bore much fatigue and overheating." — Hempel and Arndt's
Mat. Med. from Gross in Archiv. VII, 2, 30.
Dr. Gregg attaches much importance to the symptoms : ex-
pectoration free in the morning, or expectoration at night, but not
216 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
during the day. Also, stitching, darting pains through the central
portion of the right lung.
Raue mentions that the cough is better when lying down.
Lungs and Thorax. — Excruciating deep-seated pains in chest.
Lungs feel sore. General sensation of weakness in chest (Stan.) ;
has to use the whole chest to speak. Stitches in sides and chest
going through to back. Tickling itching in the region of the
supra-sternal fossa which threatens suffocation, until a deep shat-
tering cough comes on, which lasts several hours.
Cough. — Deep, exhausting; at first dry, thin, loose, with co-
pious purulent sputa. Cough produced by tickling in throat-pit ;
awakening him at night. Sensation as of a hair lying from tip of
tongue to trachea, compelling him to cough, hack and scrape.
Sputa viscid, milky, frothy, tasting greasy; or more often dense,
muco-purulent, composed largely of pus globules of musty odor,
Aggravations. — By cold drinks (Rhus) ; by motion ; by speak-
ing ; by lying down.
Accompaniments. — Great shortness of breath from exercise,
and from lying on the back ; hoarseness in the morning (reverse of
Phos.). Cough is often accompanied by swelling of sub-maxil-
lary glands. Often there is vomiting of tenacious mucus in the
morning. Want of animal heat, always chilly even when exercis-
ing. Face and head sweat on the least exertion. In later
stages of phthisis, there is often violent general heat with violent
thirst in the afternoon, evening and all night ; or periodically re-
turning heat during the day without previous chill, followed by a
slight sweat. Night-sweats, mostly after midnight, which are
sour or musty, or of a cadaverous odor. Periodical sweats at 6
a.m., 3 to 5 p.m., and 11 p.m. Stool watery, containing undi-
gested food, weakening ; or hard and difficult to expel, from in-
activity of rectum. Stool recedes after partial expulsion. Pa-
tient has great aversion to warm cooked food, especially to meat.
The well-known power of Silicea over suppurative processes
and septicemic action would lead us naturally to suppose such
power might be utilized in the purulent stages of tubercular
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 217
action, and so it has proved. Probably the advanced stage is
the more appropriate time for its use ; yet if Silex can develop
tubercular exudation, as has been supposed, why may it not
cover the earlier symptoms as well as the later ? Possibly the
tubercular deposit which has followed the breathing of quartz
dust, may have been more from mechanical irritation produc-
ing inflammation as any foreign body, the tubercular exuda-
tion following the inflammation. There is a cachexia, how-
ever, to which Silicea corresponds, and it may yet be deter-
mined that it is as much a modifier of the tubercular diathesis
as Calcarea carbonica or Calcarea phosphorica, only varying
in its type. Hughes regards it as suited to organic changes,
rather than to functional disorders; says it is even more im-
portant than Calcarea for rachitis in children.
It has a powerful action upon the lymphatic glands, pro-
moting dispersion or maturation, and as it has cured epilepsy
it must have a marked influence over the nutrition of the nerve
centres, which, if phthisis comes of loss of nerve force as man 3'
think, tends to show still further its range of applicability.
The low grade of vitality indicated by the impossibility to
keep warm, or get warm even when in motion, has much ana-
logy to some forms of tuberculosis.
Clinical. — Case 1. — Mr. T., set. about 30, of a sanguine-
bilious temperament, rather dark complexion ; five feet, ten
inches high ; weight in health, 160 lbs. ; family consumptive,
two sisters and a brother having already died, leaving a brother
still enjoying tolerable health. Had severe hemoptysis in the
summer while in the hayfield and had constantly declined
from that time. Saw him the April following, he having
passed through the hands of several physicians and at that
time was so low that his ph3 7 sicians said he could not live six
weeks, and such was my opinion on seeing him. There was a
large cavity in the right lung at the second intercostal space at
about three inches to the right of the sternum; there were
heavy rales in the left bronchi, with decided indications of
breaking down of the parenchymatous structure, and cavern-
ous lesions there also ; the sputa was very heavy and largety
purulent; there was the odor of the cadaver already present,
218 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
musty and offensive enough from septicemic influences ; he
had no appetite, and sat up hardly longer than to have his
bed made ; skin had a cold, clammy feel and he was drenched
with night-sweats. Case was marked with absence of vital
warmth — indeed, so forbidding was the case that I refused his
brother when he asked me to visit him again in a week ; he
lived forty miles away; he was given a dose of Silicea 2000 every
other night with Sac. lac. and ordered to report by mail in a
week. He had been very much harassed with his night-sweats
and cough which was worse from motion; the first mail brought
me the intelligence that medicine acted like a charm and
wanted more of the same kind. I sent so that he got a dose
of Silicea twice a week and so treated him till June when he
paid me a visit. Left lung appeared -to be cleared up; night-
sweats no longer troubled him ; appetite was good ; was stead-
ily gaining in flesh and strength. Nevertheless, in the right
lung there yet remained traces of the vomica which now was
much smaller and secreting only a small amount of muco-
purulent matter; he was furnished additional medicine and
went home and by the middle of July was on his mowing ma-
chine. Patient was alive four years after and enjoying fine
health and I do not know but he is to-day ; no man could be
more surprised than myself at these results. Were we all de-
ceived ? Three good physicians of the leading school of medi-
cine agreed about the diagnosis and I don't think there is left
a possible ground for doubt. The case is exceptional we agree,
but is it not full of suggestions ? — G. N. B.
This is a remedy lately brought to the notice of the profes-
sion, and for excessive secretion of mucus and the serous ele-
ments is invaluable. I do not know that we have any extended
proving of the drug, and hence indications for its use are mostly
drawn from clinical sources. It resembles Stannum as to the
abundance of the expectoration, but it differs from Stannum
in that the sputum to which it corresponds is more watery, is
tasteless, and the mucus mingled with the watery elements is
stringy and light-colored. If it be slightly purulent it does not
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 219
seem to be contraindicated. Usually Stannum sputa offer
much more consistence, are of a yellowish or greenish-yellow
hue and sweet of taste. We have met cases where there was
little of the yellow cast, the principal mass, which surpassed
in quantity anything we had ever seen, being of a tough,
ropy, glairy consistence, like the white of an egg, not watery at
all. Silphium has not the gone feeling of Stannum, nor has
it the concussive paroxysms of coughing. It has the symptom
of exhaustion peculiar to our cases of phthisis. The guiding
symptom then is, excessive expectoration of a thin watery mass,
with stringy mucus floating in the more liquid elements, which may
also be slightly purulent.
Dr. W. T. Laird, of Augusta, Maine, writes me that he has
prescribed it in numerous cases, where such symptoms were
present, and always with satisfactory results. " It always di-
minishes the amout of expectoration and contributes greatly
to the relief of the sufferer."
Clinical. — Case 1. — "Mrs., M. set. 39, lymphatic tempera-
ment, in the last stages of catarrhal phthisis; large cavities in
both lungs; pulse 120 to 140; hectic fever and night-sweats.
The most pronounced and troublesome symptom was a slight
cough, day and night, preventing sleep, with a constant, pro-
fuse expectoration of water mixed with light colored, stringy, taste-
less mucus, containing a few pus globules. The amount raised
in twenty-four hours was nearly three pints by measurement.
Silphium 30 afforded marked and rapid relief. In less than a
week the sputa had diminished to half a teacupful per diem.
The appetite improved and there was a slight gain in flesh
and strength. The disease, however, had made too great pro-
gress to be arrested and patient died three months later." —
W. T. Laird.
This is a very instructive case and shows pointedly the
curative action of the remedy. The question naturally arises
if we can arrest for a time the progress of a disease, why we
may not hope to bring to the aid of such reaction the means
necessary to complete a cure? Was this case supported by all
that diet could do? Were there not new indications by which
the remedy to follow Silphium could be selected? Dr. Laird
220 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
has the thanks of the profession for what he has done. Is it
not just possible, however, that he yields the ground too soon,
in saying that his remedy cures no case of phthisis, leaving
us to infer that he thinks the disease incurable?
Lungs and Thorax. — Empty feeling in chest, or great weak-
ness in sternal region. Sore feeling in the chest; stitches in left
side of the chest when breathing, or when lying on the left side.
Tendency to hemoptysis.
Cough. — Dry, concussive, apt to be in three paroxysms ; short
cough from time to time, as if from weakness of the chest; desire
to cough as if from sense of constriction. Cough and expector-
ation followed with great weakness of chest and voice ; too weak
to talk. Cough with copious sputa, glairy mucus, like the white
of an egg, streaked with yellow or greenish-yellow pus; sputa also
yellowish-green, tasting sweet or saltish, sometimes sour and
raised most abundantly in the morning. Very abundant sputa a
Aggravations. — By singing, laughing, lying on the right side
(reverse Phos., Lycop.), and by warm drinks (Phos.).
Accompaniments. — Reading aloud or talking produces
great exhaustion; great weakness of the legs; patient drops into a
chair, instead of sitting down with ease. Oppressed breathing
when lying down, more in the evening, increased by movements.
Chill at 10 A.M. (Nat. mur.), with numbness of finger-tips, or
in the evening over the back; chill slight but with chattering of
Burning heat in the hands evenings; hectic fever; sweats
night and morning, and most profuse on the back; perspiration
smells mouldy (Sil.).
Pulse frequent and small, trembling.
The reputation which Stannum has gained in the cure of
consumption can hardly be based upon mere accident, though
to what extent it is able to disperse tubercle when existing, we
are not yet fully persuaded. It seems to cure both catarrhal
and scrofulous consumption. We incline to the opinion that
its greatest service will be found in cases largely catarrhal
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 221
which have been grafted upon a scrofulous habit; tubercle
affecting more particularly the mucous membrane would be
its most effective plane.
In our own experience it has corresponded to an abundant
secretion of mucus relatively, even when muco-purulent, tlie
empty feeling in the chest an important characteristic.
Clinical. — Case 1. — "A gentleman, set. 36, of a phthisical
habit with hereditary consumption in the family, pale, ema-
ciated, breathing short and puerile; troubled with a cough
which is sometimes dry, but morning and evening coughs up
a greenish-yellow matter of a sweetish taste. The physical
signs are flatness of the thoracic walls, diminished resonance
and broncophony; has headache, aggravated by the cough;
small stools and urging at the rectum ; hands cold and feel
heavy; feet cold and oedematous; hectic flushes; much thirst;
appetite good, but food disagrees ; eating followed by pain in
the epigastrium; cured in a few weeks by Stannum." — Hitch-
Case 2. — A Mrs. Powers, set. about 40, abandoned by two
physicians to a hopeless phthisis of the lungs; she had had a
hard swelling upon the neck a few months previous to com-
mencement of her chest troubles; discussed with iodine by
advice of her physician; found her with a pulse of 160, small
and trembling; physical examination showed dulness in the
upper portion of right lung and voice sounds at the middle of
third intercostal space three inches to the right of the sternum ;
heavy rales as of air passing over quantities of matter in a
fluid state ; cavity seeming of unusually large size, although
expectoration was not so heavily purulent; the quantity ex-
pectorated, however, was simply enormous; estimated to be
fully a quart for every twenty-four hours ; much of this was a
thick glairy mucus, streaked with greenish veins or yellowish-
green ; there was a weak feeling of the chest, and voice was
weak; raised more in the morning, coming up by severe
coughing turns, and sputa tasted rather sweetish, sometimes
salt; both the walls of the vomica and the bronchial mucous
membranes must have been active secreting points to have
furnished such quantities of matter. I first gave Calcarea
222 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
carb., which was not the simillimum; pulse fell to 123, and
expectoration fell off about one-fourth; no additional improve-
ment followed the medicine; three weeks, later I gave Stan-
num 3 , and six doses cured the case, given at increasing inter-
vals for six weeks. — G. N. B.
Lungs and Thorax. — Pulsations at right side of the sternum,
going down to epigastrium. Oppressive pain in left thorax un-
der fourth rib. Oppression in the chest as if a hard mass were
Cough. — Hard, racking cough provoked by inspiration; dry-
cough in the evening and at night; loose cough in the morning
with more scanty expectoration as the day advances. Incessant
wearing, racking cough in consumptives.
Aggravations. — In the evening and from lying down.
Accompaniments. — Splitting frontal headache. Pain in left
side below scapula. Tickling in bronchi and larynx. Rumbling in
abdomen with pain from sternum to spine.
Lungs and Thorax. — Congestion in chest from least exertion.
Burning, soreness, and sense of great heaviness in chest. Stiches
in both sides of chest. Tuberculosis in apex, of left lung.
Cough. — Chronic cough attended with violent paroxysms, in
which small hard tubercles are thrown off. " Cough dry and sibi-
lant, sounding like a saw driven through a pine board; each
cough corresponding to a thrust of a saw."
Aggravations. — From eating sweet things ; from cold drinks ;
lying with head low; in a warm room; in dry cold winds and
Ameliorated from taking warm food or drinks.
Accompaniments. — Motion exhausts one particularly in the
chest; sudden attacks of weakness while walking, which causes one
to totter, while the blood seems to rush into the chest as if some-
thing would burst. Severe dyspnoea, relieved by bending body
forward, worse from lying down. Voice gives out in talking or
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 223
singing. Suffocative attacks; throat symptoms relieved by re-
cumbent posture. Nausea with faintish weakness. Canine hunger,
and swollen thyroids.
Lungs and Thorax. — Dulness on percussion ; sensitive thoracic
walls; sore spots in the chest; soreness in upper portion of left
lung going through to scapula (Myrtus). Pain in scapula and right
intercostal spaces when coughing. Lungs feel as if they touched
the back. Pressure in the chest; contractive pain around the chest,
sensation as of screwing together in the chest. Cutting and burn-
ing deep in the chest after a walk in the open air.
Burning in chest with heat arising to face.
Feeling of coldness in the chest; sometimes as if a lump of ice
were in the right chest. Rattling in the chest. Weakness in chest
Cough. — Dry, short, violent; occurs both day and night, but
apt to present typical periods early in the morning or on going
to bed. Dry cough with hoarseness, worse nights. Sometimes
patient wants to cough, but is not able. Much coughing at
night on going to bed (Hepar), with heat in the head, especially
crown of the head and face. Cough caused by mucus in the
bronchi, morning mostly when the air passes over into the air-
cells. Painful shocks in the head when coughing.
Sometimes there is a loose cough with soreness in chest, or
pressure with expectoration of thick mucus; vomiting when
coughing (Bry., Sep.). Much rattling of mucus in the lungs.
The cough worse in the morning, relieved by sitting up
(Spongia). In one case we noted aggravated by Sulphur; there
was great rattling and difficulty of breathing with considerable
expectoration, yet not enough to begin to clear the bronchial
passages. Cough frequently seems to be provoked by an irri-
tation at the ensiform cartilage, especially when the cough is ac-
companied by gagging, and head symptoms. Sulphur has
proved curative in coughs attended with expectoration of blood
mingled with pus; with sputa consisting of greenish lumps, or of
thin, milky fluids, mixed with pus-globules ; and with putrid sourish
sputa offensive to taste and smell (Psor. Sang.).
224 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
Aggravations. — From talking; from eating; from taking
air in upon the lungs (Natr. mur., Phos.); from walking in the
Accompaniments. — The throat is apt to feel rough and dry
with a burning sensation in the trachea. There is sudden arrest
of breathing when turning in bed. There is unsteady gait and
trembling of the hands. Chill occurs at any time in the day,
but more likely to occur in the evening; mostly internal and
without thirst; the chill may be external with internal heat at the
same time. Another phase is a chill with thirst preceded by
heat; the chill often begins on the back of the hand or on the toes
and runs up the spinal column. Again we have flushes of heat
coming frequently followed with a slight perspiration and faint-
ish feeling; burning palms and soles are quite characteristic. There
are profuse sour-smelling sweats the whole night; or sweats in
the morning, and in the evening ; in the evening mostly on
the hands; in the night on the nape and occiput. Cramps in
calves of legs at night, and in feet — inclined to put feet out of
bed because of heat.
There may be many associated symptoms, such as diarrhoea
driving one out of bed in the morning; hunger and faintness at about
11 A. M.; heat on the vertex; itching upon the integuments, or at
the throat and anus, which gets worse in bed; disgust amounting
to nausea about any effluvia coming from his own body; head symp-
toms worse after dinner, inclination to vertigo with falling to left
side; freckles and black pores on the face; smell before the nose as
of an old catarrh, wants the doors and windows open for want of air.
Drowsiness in the day-time and wakefulness at night. Chronic con-
stipation with hard, dark and dry stools, requiring much strain-
ing to expel (this last symptom was noticeable in one of our
cases reported below) ; soreness, excoriations, exudations and
itching of the anus; lancinating pains in anus; fistula in ano and
The rank the great Hahnemann gave to Sulphur as an
anti-psoric, or exterminator of the root of -chronic diseases is
none too great, and well illustrates the acuteness of the man's
observation and the scope of his generalization. We knew
little of the power of the remedy till we had been in practice
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 225
many years, and feel that we very poorly know how to teach
the conditions that govern its higher functions now. In con-
sumption everything depends upon the potency; the lower
potencies are vile or pernicious. I once provoked fatal activ-
ity of the secreting vessels in a pulmonary consumption with
a third potency, so that my patient was absolutely drowned
out. We must caution against too frequent repetition and too
low dilutions of Sulphur in pulmonary phthisis. Fincke says :
" With single doses of Sulphur 55m , I have cured numerous cases
of incipient phthisis." Our most pronounced cures have been
with the 100 m , Fincke; one hardly less pronounced with 2G m ,
Fincke ; and how this is we are unable to say ; 200th and the
6th had been tried with no results in one case ; lastly, this case
was cured with a single dose of 20 m , Fincke. It is almost too
much to believe, but we must report the facts let the reason be
found out when it may; there is still something for us to learn.
We have spoken of Sulphur as an anti-psoric from the Hahne-
mann standpoint ; a term to express a diathesis productive of
tubercle and other chronic morbid phenomena. The action
of Sulphur seems to be primarily upon the sympathetic system
of the nervous chain, or the seat of organic life; under the
guidance of the ganglia of this system of nervous force the
processes of nutrition and alimentation go on; the functions
of the stomach, liver, pancreas, spleen and mesenteric glands
are all modified by the action of Sulphur operating through
this ganglionic chain ; it acts upon the skin and entire mucous
membrane. Acting upon the glands and follicles as it does, it
is easy to explain its great power as an absorbent, suggesting
that it can be utilized in the matter of drainage of the system.
The taking up of debris and adventitious products and causing
their elimination out at the natural sewage, is most important
to health. As an electric it is negative to all known substan-
ces and the exact opposite of oxygen, which is positive to all
known substances ; this may be of more significance than we
think. I should place the service of Sulphur then largely as
that of an eliminating element. Substances refused by the
morphic or structure-building forces need to be removed and
carried out at the waste-gates of the body, such as the skin,
226 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
lungs, kidneys and alimentary tract; broken-down structure
or the refuse left from the combustion which liberates force,
has to be conveyed away by these same channels. In tubercle
we have exudation of albumen, the substance produced by the
first processes of digestion; as Sulphur acts upon the entire
class of functions operating to produce albuminoid and fibri-
noid products, it is fair to presume that it can be utilized in
molecular movements antecedent to the deposition of tubercle,
and further acting as our most efficient agent in removing
certain kinds of exudation, notably albuminous and fibrinous,
it is fair to presume that it can be utilized to remove tubercular
exudation. Wurmb, in his studies of pneumonia, has based a
successful generalization for the use of Sulphur upon patholo-
gical anatomy, and it is about the only generalization of the
kind ever made. "If pneumonia," he says, "be not compli-
cated with other diseases, then generally there comes a period
when the febrile storm subsides; the pains, the dyspnoea, etc.,
cease — in short, the patient feels himself greatly relieved as
soon as the infiltration has become complete; at this period
art can have no other problem than to support nature ; while
she, for the sake of removing the exudation, increases the ac-
tivity of the processes of absorption, or on the other hand to
oppose nature in case she shows a disposition to get rid of the
pneumonic infiltration by a purulent degeneration. Now in
our view no remedy yet proved corresponds so well to these
indications as Sulphur; none compares with it in point of
certainty and celerity of action. Sulphur penetrates the entire
organism even in its finest and most recondite portions. It
increases the activity of vegetative life generally, and the pro-
cesses of secretion and absorption in particular; it accelerates
the interchange of elements and makes it more pervading; in
a word, it fulfils all the demands upon which the removal of
an abnormal product is conditional. Upon these grounds we
apply Sulphur to the removal of pneumonic infiltration of
serous exudations of old as well as recent deposits in the skin,
the parenchyma, the joints and bones." That it does remove
pneumonic infiltrations no one denies; that it does remove
tubercular exudation I am almost as positively assured. The
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 227
products of pneumonic infiltration, or hepatization are unlike
the exudation called tubercle; both, however, are the products
of inflammation, and pneumonia supervenes upon tubercular
irritation, and it would appear that tubercular infiltration
often follows pneumonic inflammation. Persons subject to
repeated attacks of pneumonia usually die of phthisis; to this
fact our attention should be carefully given; if the same gen-
eralization made by Wurmb in relation to pneumonic infiltra-
tion should finally be found to apply to tubercular infiltration,
science surely will have made a point and humanity have
cause for thankfulness. The generalization founded upon the
scrofulous diathesis, the evidences tending to show exudative
obstructions and temperamental and antecedent peculiarities,
governed our choice in two of our phthisical cases more than
any pathogenetic symptoms we were able to gather up. There
was concurrence, but too much generality to get at sharply
defined indications. This ver}^ breadth of impression may be
a valuable symptom ; molecular movements like the begin-
nings of a great storm may be slow and cumulative, but all
the more significant for the wide scope and sphere of the
movements. In our cases of phthisis we are to study heredity,
the forces of nutrition and the functions of elimination pro-
foundly; we are to examine by physical and other signs for
impediments from exudative matter. Conjoining our patho-
logical studies with the study of our provings, we shall render
the best possible service to our patients. We formulate the
proposition that as the ganglionic system is the primary and
fundamental seat of life, it is presumable that the hereditary
elements of disease are contained here. The action of Sulphur
being so energetic upon the system, more than any other
remedy it may be expected to meet and overcome the tenden-
cies to degradation of morphic forces in the nascent state, even
to the removal of hereditary influences.
Clinical. — Case 1. — Mr. P., set. 33, nervous-bilious tempera-
ment, with blue eyes and light hair. Grandfather, several
aunts and an uncle had died of consumption, also mother and
three sisters; the latter, all the sisters he had, died before reach-
ing the age of 25.
228 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
He began to decline with the following symptoms: severe,
dry, irritating cough which after a while ended not unfrequently
in gagging and spitting up a little tough mucus, or ejecting
from the stomach a little sour fluid; was much troubled with
pyrosis, little desire for food, and if eaten attended with much
distress; emaciated quite rapidly, and became despondent
under the impression that he would soon follow those of his
family, who had already died of consumption. Bowels were
badly constipated; dullness of lungs on percussion, and atten-
uation of the thoracic muscles strongly supported the inference
of tubercle in the parenchymatous structure of the lungs ; two
or three remedies were tried with no apparent results, certainly
no curative results. At this time I concluded to take the con-
stitutional diathesis as the basis of my prescription, and gave
Sulphur l00m , medicating three powders and giving one with in-
structions to take one each week. At this time patient looked
sallow and haggard in countenance; had been afflicted with
an inveterate constipation for nine months, an aggravated
dyspepsia accompanying the harassing cough and more re-
cently night-sweats. When my patient called upon me again
in three weeks he was so much changed as to astonish me;
his constipation had given him no trouble whatever from the
time he took the first dose of Sulphur, indeed, the whole mor-
bid chest and abdominal symptoms were rapidly passing
away ; he got three or four more powders of Sulphur in the
next six months and was discharged cured, and has so re-
mained. I think there was no question about the character of
the disease or the fatality that would have followed in a few
months, had not curative action been established ; there were
no cavities in this case and of coure no septicemia, and yet it
is a very suggestive case when put with two or three more
which will follow. — G. N. B.
Case 2. — Miss C, milliner by trade, set. 30, of sanguine nerv-
ous temperament, family consumptive, has had a dry cough
for several months and been getting weaker and weaker grad-
ually; been under the charge of a homoeopathic physician a
long time. At our first visit found her just able to be about,
but had given up all business; apex of left lung was dull from
PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 229
above third rib, and rales could be heard from a small cavity
opening there, also voice sounds; was expectorating a small
amount of muco-purulent matter which was raised with diffi-
culty ; cough much more of a dry than a loose character. She
had stitching pains going through from the front of the upper
left thoracic region to the scapula, and was sore in front from
pressure and tender from percussion ; had hectic fever with ac-
companying chills and sweats, though sweating was not so
marked as in some cases. On consulting with her physician,
found that many remedies had been tried — Sulphur low and
also 200. I said, I saw but one remedy indicated, and if
Sulphur would not help her, knew of nothing to be done, and
gave her Sulphur 20m , not to be repeated for a week ; in about
six days she showed signs of improvement and got no other
remedy; recovered in a few months so as to go on with her
business, and is yet living so far as known. Many will be
skeptical as to the correctness of our diagnosis. I was aston-
ished at the effects of the medicine, but feel pretty confident,
that there was not only tubercle there, but that a cavity was
well formed.— G. N. B.
Case 3. — C. W., set. 37, a lawyer by profession, and at the
time of being taken down, a member of Congress; began to
decline the second year of his stay in Washington ; of the nerv-
ous sanguine temperament, tall and spare with light hair and
blue eyes; had consulted several physicians before coming into
our hands, and among them Dr. Bowditch of Boston, all of
whom pronounced the case one of tuberculosis of the lungs;
came into our hands the last of June, 1872. At that time suf-
fered from a severe cough attended with very considerable ex-
pectoration of a rather tenacious character, largely composed
of greenish mucus with traces of pus-globules among the more
greenish portions; much of it would almost rope; voice was
weak and hoarse, and patient was able to sit up only one-third
of the time ; very little appetite, and given to a great deal of
shuddering, and so pronounced a chill as to be followed with
considerable fever; chill came on daily and in the forenoon
usually began on the back of the hand, or on small of the back,
and ran up the spine; night-sweats of a sourish, unpleasant
230 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
odor, staining under-garments. Physical signs showed apex
of right lung to be the seat of tubercular infiltration. Several
remedies were tried. Phosphorus in particular; taking the
constitutional diathesis more into account than any detail of
symptomatology, though they were of Sulphur as much as
anything ; prescribed at last Sulphur 100 ™, and with so decided
an effect as to have our attention called to particular sensations
on meeting patient two days after, prefaced with the question :
"Doctor,, what did you give me at your last visit?" We were
also told that he was feeling better than for a long time. Did
not repeat the dose for fourteen days, using a placebo in the
mean time; when we did repeat the dose, it was put in among
the same powders we were dealing out to amuse our patient with,
numbered so he might get it first; what was our surprise to be
promptly told on our next meeting that we had given again a
dose of the old medicine. We asked "How do you know?"
"By my feelings," was the reply. He was a man of the cold,
intellectual type, believing very little in homoeopathy or any-
thing not appealing to reason directly, in fine, the last man to
be given to fancies. He got well in the course of the next
twelve months; that is, he got well of his cough and recovered
so far in his general health as to be in his seat at Washington
the next winter, and the summer following attended to legal
and editorial business with greater ease than for the ten years
previous; but within eighteen months he had fistula in ano. —
G. N. B.
Since my leaving Vermont the gentleman has died of phthi-
sis, some nine years after above treatment. We have numer-
ous other cases of interest and suggestiveness, especially where
high potencies of Sulphur have been used; we have never seen
any good follow in this class of cases from the use of low po-
tencies of Sulphur; in the second case mentioned above, the at-
tending physician had used Sulphur 4th and 200th, so he said,
and with no satisfactory results. I have myself given Sulphur
4th and 200th with scarcely perceptible effects, and with 20 M.
seen prompt curative action follow; even brought out the patho-
genetic symptoms, or my patients have woefully deceived me;
and how they could, not knowing the symptoms of the remedy,
PHTHISIS PULMONALIS: TUBERCULAK PHTHISIS. 231
is difficult to conceive. I confess to astonishment, but must
believe where we can no longer doubt. That we have tried
and failed we do not deny, but that we have succeeded at all
is the greater wonder, and we do not expect our cases to be
taken without grave doubts by the most of our brethren ; we
give the cases with all the suggestiveness that follows in all
honesty of purpose and with great hope for the future. How
it is that our higher potencies have done for us what the lower
failed to do, we are unable to say, and yet there is never a fact
without a reason. Whether disease plants itself on a molecular
basis or takes root in the vital principle, and because of this,
demands molecular force for its dislodgement, one can answer
as well as another. If we shall elicit investigation and further
trial in this rather new field, we shall have done all that is
intended by the publication of these cases. The wisest thing
to do will be to keep watch and ward off the people and wher-
ever opportunity allows, see to it that the inceptive stages of
this terrible scourge be promptly dealt with, by removing the
consumptive d} r scrasia, even from the foetus in utero if oppor-
tunity offer; moreover we should arrest any other drift of ob-
struction tending to the thoracic organs, knowing full well
that the earlier an evil is dealt with the better the chances of
success in the treatment. That we have remedies which if
administered in season are competent to arrest a large per cent,
of these cases, there remains no longer a doubt in our own
mind ; it is time to begin to deal with life ad initio.
Case 4. — "H., set. 25, when a child had crusta lactea; he-
moptysis when 20 years old, since then constant, dry cough, dif-
ficult breathing; after six months a second bleeding-spell, and
again a third followed by unmistakable symptoms of phthisis.
Symptoms: lying on his back, great emaciation and pallor,
constant fever with aggravations in the p. m. and copious
clammy sweats, especially on the anterior surface of the body;
cough with tuberculous expectoration, at times consisting of
clear pus; cough more frequent, more violent and more dry
during the aggravations of fever; looser and with increased
expectoration during the sweat; dull ache in different portions
of the chest; especially and from the very beginning at a place
232 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
between the third and fourth left ribs where physical examin-
ation proved the existence of a large cavity; loss of appetite,
thirst, diarrhoea, oedema of feet, sleeplessness, lassitude, indif-
ference. Gave Sulphur 2000 , one dose; it produced early im-
provement and after two months disappearance of all the
symptoms; after seven months a little cough removed by Sul-
phur; after three years still perfectly well." — Allg. Horn. Zeitg.
XXXIX, 203, from a Spanish Journal.
Case 5. — " M., get. 30, thickset, without hereditary tendency
to phthisis, when a student had itch suppressed ; venereal ex-
cesses and intemperate; has had trouble with his lungs for
last eight years. Symptoms: pressure and tension in chest
and epigastric region; sensation of constriction in the chest;
to relieve this and to get breath, he is obliged to throw back
his shoulders. Has had frequent spitting of blood; expector-
ation at present very salty, purulent, sometimes streaked with
blood; digestion good; blind piles; sleep uneasy, cannot go to
sleep on account of great dry heat. Sulphur relieved him in
a short time so that the progress of the disease was completely
arrested ; his lungs are somewhat sensitive to cold air, but all
during the years which have elapsed since then he has been
able to look after his business in all sorts of weather, fair and
foul." — Griesselich in Hygea, II, 355.
Case 6. — " H., get. 25, when a child had itch suppressed by un-
guents. Symptoms : Cough so violent that it terminated in chok-
ing and vomiting, and the patient fell back utterly exhausted, his
forehead bathed in cold sweat, with the cough, stitches in the
chest here and there which did not, however, create difficulty
of breathing; cough worse at night, incessant, returning as
soon as he closed his eyes ; expectoration copious, clear pus,
horribly fetid ; very poor appetite; extreme lassitude; drench-
ing night-sweats, despairing mood. Gave Sulphur 30 , one dose
each day; cough better in a short time; the night-sweats be-
came more moderate ; gain in strength ; could go out in three
weeks." — Kreussler in Allg. horn. Zeitg., XXIX, 154.
Case 7. — " Man, get. 38, of delicate physique and cachectic
appearance, in ten years has had twenty attacks of bleeding
from the lungs; he was bled in each case and suffered after
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 233
every paroxysm, and for weeks following from cough with
profuse purulent expectoration. Symptoms : The bright red
blood was expectorated in large quantities, accompanied with
rattling in the trachea, and usually by choking and gagging,
with painful soreness in the chest; feeling of anxiousness;
palpitation of the heart; cold hands; oppressed breathing; in
former years an attack of itch had been suppressed; this was
followed by headache, later by these paroxysms of cough with
bloody expectoration. Gave Sulphur 2 , one dose every hour;
in the evening no more bright blood ; on the following day
the expectoration of dark blood had also disappeared, and the
patient could see to his business ; under the less frequent use
of Sulphur the pus-like expectoration was removed in a few
days." — Elwert.
Case 8. — "L. D., set. 45, has had a cough for many months,
attended with emaciation; the symptoms are a dull heavy
aching on the chest, with dulness on percussion, over the lower
right lobe, very marked, accompanied with crepitation ; chest
feels weak; expansion of chest one inch; weight of person 134
pounds. Prescribed Phosphorus every night for ten days, and
gave Scott's Emulsion ; ten days later crepitus a little abated.
Gave Sulphur 30 , one dose, and no more medicine for a month ;
two months after commencement expansion of chest 2J inches,
weight 135 J pounds; has taken a little cold, for which Bryo-
nia 200 was given ; six months later all traces of condensation
had disappeared, and had increased much in flesh." — N. C.
We have no extended provings of the drug, and whether it
differs from phosphate of lime or not, I am unable to say; it
is composed, as we understand, of the cretacious matter which
comes from the transformation of the caseous or albuminous
infiltration called tubercle; it is probably a compound of phos-
phate and carbonate of lime with soda, and possibly some
other minerals. The remedy has been only recently intro-
duced, and we have had no experience except in two cases
234 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
where we have attributed very decided curative effects to it,
and if we are not mistaken it will prove a very valuable addi-
tion to our remedies for the treatment of consumption.
Dr. Swan reports a case with the usual features of the last
stage of pulmonary phthisis, great emaciation, constant cough,
purulent expectoration, profuse night-sweats, cured by Tuberculi-
num, M. M. and C. M. M.
Clinical. — Case 1. — Jennie J., set. 15, a blonde, unusually
bright, and much in advance of her years intellectually, has
led her classes at school, and made beside much proficiency in
music, has been very nervous, easily excited for weeks, and
often irritable, and then again moved to tears. Has been
coughing more or less for two or three years ; had chills and
fever a year ago, and came down in March with chills again,
as was supposed. Chills in the afternoon with almost continuous
fever; cough, and pains in the chest, particularly the upper left
side; all the symptoms about the chest aggravated with the
setting in of chills and fever; chills from 6 to 8 evening, but soon
settled down to 7 p.m. ; fever after a little abated in the fore-
noon and all through the night till near morning, when a sour
sweat sets in, pulse however keeping up all the time to from
110 to 120; walls of chest very tender, and much more so at
about three inches below the left clavicle, where is found con-
siderable dulness on percussion; also bronchial sounds are dis-
tinctly heard in this region ; expectoration of a trifle of yellow-
ish mucus, with possibly traces of purulent matter. Diagno-
sis: cheesy condensation, with the fever attending tubercular
infiltration, but no cavities; complicated with a malarial
cachexia. The chills were arrested, or partly arrested at least,
by Lycop. 200th and 10 M. Fever, however, continued, so that
pulse only fell to 110, till Tuberculinum was given. It then
went down to 100 per minute. The appetite, which previously
was entirely gone, began to reappear, and visible improvement
was seen in strength, looks, and otherwise. The preparation
given was C. M. (Swan).
I repeated the remedy for return of some symptoms after
two weeks, followed by more marked improvement again ; pa-
tient steadily improved, till cough entirely disappeared, as
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. Z3o
well as the soreness about the lung. Menstruation, which dis-
appeared early in her attack, was again set up after the sixth
month, patient having gained fourteen pounds in weight. Two
or three times she took Lycopodium for some febrile symp-
toms with the 4 to 8 aggravation, after being put upon Tuber-
culinum. There may properly arise a question if the case be
not more attributable to Lycopodium than the Tuberculinum.
We think not, from our standpoint, and we are probably best
able to judge. The rebound which followed from the first dose
of Tuberculinum, and which followed at subsequent periods,
leads us to believe it was the one remedy which saved our pa-
tient, though Lycopodium did something very creditable for
the chill and febrile paroxysms.
Patient almost at once began to eat and assimilate food after
taking Tuberculinum, a thing she had not done for months.
She showed a remarkable relish for beer and for fat boiled
pork, the first being allowed her with malt, and the last taken
as she liked. Cream and milk, to which was added either
wine or brandy, was also given.
Case 2. — Dr. Nichols writes from Boston that Calcarea pul-
monica om , potentized by Dr. Swan, acted most favorably upon
a cough attended by the expectoration of calcareous matter.
The patient, a blonde female, set. 18, had lost two sisters by
pulmonary consumption. I do not quite know if this be Dr.
Case 3. — Another case presented the usual features of con-
sumption in the last stage : " Great emaciation, constant cough, pur-
ulent expectoration, profuse night-sweats." Tuberculinum mm + cm .
— Dr. Swan.
Case 4. — "A man given up to die was emaciated to the last
degree; cough with sweet, yellow expectoration, night-sweats and
very weak. Tuberculinum mm , Sepia mm and Phosphoric acid cm ,
helped him so much that he went to Manhatten Beach to com-
plete his cure; got to eating finely; had no night-sweats and
very little cough." — Dr. Swan.
Case 5. — Dr. A., set. 26, blonde, light hair and blue eyes, of
a scrofulous habit; began coughing a year ago; health failing,
and cough proving obstinate; was examined by Dr. Willard,
236 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
of Alleghany, New York, and the physician in town. Diagno-
sis: condensation from tubercular deposit in the apex of the
left lung; depression at the third rib; was soon taken with
pleuritic pains followed by fever, which ran on into a hectic
with chills, night-sweats and purulent expectoration; for
months ran steadily down, till considered hopeless by all
friends and her physician ; was so feeble indeed, that she could
not be moved; sent her one dose of Tuberculinum about the
1st of July; soon after astonishing changes followed with im-
provement in all the lung symptoms ; fever and sweats almost
entirely disappeared. A second dose of Tuberculinum was
given August 12th ; improvement continued and patient was
able to be removed to New England, where she mended a little
and then died. — G. N. B.
These cases are reported for the purpose of calling the atten-
tion of the profession to the use of this remedy in phthisis.
Some express great disgust at the mention of a nosode.
Psorinum has had a place in our Materia Medica for a long
time, and some of our best physicians report excellent clinical
results from its use.
What we want are facts in the case, and if we accept Calcarea
phosphorata as a remedy from the mineral plane, why may
not the cretaceous products of tubercle when potentized become
a remedy as well? Its value is to be settled by trial. This is
about all there is to the question. The case of Miss Young
continued to improve, and menses appeared after a cessation
of six months. An eruption appeared about the nose as she
began to improve. She may be said to be fairly convalescent
and enjoying better health than for three years at this date,
eleven months from beginning of treatment.
Water. — Sandozy has discovered that the hypodermic injec-
tions of water wonderfully controls the cough of phthisical
patients. The explanation will be found no doubt in the ner-
vous vibrations produced.
We often feel the need of some agent to relieve this harass-
ing symptom, and this will not impair nutrition as would
morphine, a remedy never to be given until the very last stage
of the disease.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 237
"We have had no experience in the use of this agent, but
shall try it when our simillimum fails, and such perplexity-
Lungs and Thorax. — Sticking in left side of chest, with
painfulness of left nipple.
Spasmodic sensations in lungs and heart. Burning in chest ; cut-
ting pains, with sense of constriction.
Rawness and roughness are felt both in throat and chest.
Cough. — Lasting all night; cough with shooting pains passing
to the stomach, pains relieved after raising a little. Bloody ex-
pectoration is frequently met with ; or spitting of blood after
a hard coughing spell, followed by burning and soreness in chest.
Sputa sometimes yellow, purulent, tenacious; or sweetish sputa
with a metallic taste.
Blood raised in the morning and during the day.
Aggravations. — All lung symptoms worse after eating sweet
things, partaking of wine, and after menstruation.
Accompaniments. — Dryness in larynx. Cramp-like pain in
external muscles of throat when swallowing. Jerking of the body
Chills begin after dinner, in open air, just before a storm, run
down the back alternating with heat. Sweats towards morning.
Zincum is a remedy we have used but little, but it has a
clinical record entitling it to a place among our remedies for
I regard it as best adapted to those cases where the nervous
system shows intensity of action, possibly where anaemia exists
and where nervous shocks, as in onanism or mental grief, are
a cause. Provers, however, find the remedy to have very
pointed direction toward the respiratory mucous membranes, and
the stitches in the chest would indicate that the parenchyma
was also affected. Purulent sputa also indicates its adapta-
bility to the severer forms of lung degradation.
In phthisis, where many symptoms seem to sympathize
strongly with the female reproductive organs, with much dis-
turbance of the sensorial and reflex system of nerves, we are
likely to find our simillimum in Zincum.
238 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS.
Some affirm that phthisis itself has a primary start in the
nervous system, and find an indication for the use of Zincum
in this hypothesis. Such generalizations, however, can be of
but little use practically; it has a clinical record of very high
value in paralytic affections of the brain such as follow from
serous exudations, and tubercle may be behind this exudation.
It is well to remember this fact, as it may point to a force in
the drug capable of modifying the tubercular dyscrasia.
FAVORABLE SYMPTOMS FOLLOWING THE ACTION
OF A REMEDY, ACCORDING TO NIESSER'S
1. Swelling of the glands in the axilla.
2. Rheumatism in the muscles of the neck, shoulders, thorax,
hips or extremities.
3. Swelling of the glands of the neck and ear.
4. The materia peccaus rises from within toward the outside,
contrary to the air which passes during respiration from with-
out inward. The chest feels lighter, but the trachea and lar-
ynx become affected in a manner to produce hoarseness,
which subsiding, the nose becomes sore, and finally ends with
pimples and pustules around the nose. This soreness, followed
by pimples and pustules, was especially noticeable in the case
of Miss Young, reported cured by Tuberculinum and Lycopo-
5. The ears become affected, from mere ringing in the ears
to suppuration within them.
6. The eyes become inflamed.
7. Headache and toothache set in ; in such cases let the pa-
tient suffer; a sudden suppression of them would quickly bring
back all the troubles in the chest.
8. Eruptions on the thorax with or without itching in the
chest or back.
9. Sweating of the feet.
10. Hemorrhoidal irritations and tumors.
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 239
11. Violent colds in the head, which indicate Aeon, or Phos-
phor., and which almost always act beneficially.
12. The morbid action goes down into the intestines, and
throws out' gall and acid, mucus, or gas, until finally it de-
velopes itself in a cutaneous disease, first attacking the head,
the upper extremities, the thorax, and so on down like
When a well-selected remedy brings forth any of these
symptoms, never disturb its action by change or repetition.
In the case of Mr. Willard, fistula in ano, followed the im-
provement of the lungs from Sulphur 100 " 1 .
In the case of one lady the invasion of the lung followed
from the cessation of activity in a lupus upon the face which
had first appeared in the eyelid upon opposite side, metastasis
following from the use of Kali carb., low. Another from the
discussion of a glandular tumor by Iodine.
MODE OF ADMINISTERING REMEDIES.
We have come to the conclusion, after careful observation,
that it is not well to repeat a remedy more frequently than two
or three times a week, and perhaps not as frequently even as
that; in our best cures the remedy was only repeated three or
four times in two or three months ; in one case only one dose
was given, no improvement showing for the first six days, but
thereafter it was continuous to a recovery; it was where a
small cavity had opened up about two inches below the clavi-
cle, on the left side; the remedy was Sulphur and the 20 M.,
Fincke. In a very grave case cured by Silesia, patient got
about two doses of the 200th a week for six weeks or so. In a
case cured by Stannum, patient got four doses in all of the 3d
centesimal trituration. In one case where Sulphur was given
in the third dilution at night and repeated in the morning, so
excessive was the aggravation that patient died in four days
from excessive accumulation of fluids in the bronchioles. We
are satisfied that both Phosphorus and Sulphur are liable to
240 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS.
dangerous aggravations, and do not know any other remedy
that may not have its dangers when administered to patients
in the tuberculous state, either too frequently or in too crude a
form. We are glad to be able to add other testimony, and
quote from the Counsellor, Dr. D'Espiney, of Nizza, France,
who says : " Of fifteen years practice, and since I began to use
dynamized drugs I have seen many cases of phthisis singu-
larly ameliorated or cured under homoeopathic treatment, and
my confidence is established. But I found out a while since
that my patients succumbed more rapidly than formerly, and
I became convinced that in certain forms or periods of phthi-
sis the inconsiderate employment of homoeopathic drugs may
sensibly accelerate the fatal issue." Dr. Charge' is of the same
opinion; he, being asked one day about the use of Phosphorus,
and especially its repetition, replied, that he put the same
question to Rummell, who replied: "Phosphorus always suc-
ceeds with me when I know how to give it." "And what do
you mean by knowing how to give it?" "A dose every fifteen
days." Charge' adds : " Rummell is right. In certain cases of
phthisis some drugs, and especially Phosphorus, may produce
the most horrible ravages when we repeat the doses too close '
together." He then adds: "About fifteen years ago I was
accidentally in a city where I was requested to visit a nun
suffering from a slight tuberculous infiltration in one apex of
her lungs ; her general health was still good ; she only com-
plaiaaed of a little dry cough, and the expectoration contained
sometimes streaks of blood ; she was a blonde, small and ten-
der, with blue eyes, white teeth, and fine complexion ; she re-
ceived three powders, each containing ten or twelve globules
of Phosphorus, with the advice to dissolve a powder in nine
spoonfuls of water, take three times a day a spoonful for three
days, and then omit three days, and thus continue till finished.
I returned to the city in about forty days, and was horror-
stricken when she appeared. The pulmonary lesion had fear-
fully progressed, whereas formerly it was very slow. I was
told that after taking a few doses a serious hemorrhage set in.
The medicine was continued till a more serious bleeding fol-
lowed." The more serious and dangerous our case the more
PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 241
caution are we to take in the administration of our remedies.
The more danger from repetition and low dilutions.
The author in giving his experiences upon dilutions and in
quoting the experiences of others has no other object in view
than that of reaching the exact truth upon the matter under
discussion. As a controversialist we join no party but claim
the right to use any and all dilutions ; and yet our experience
we feel bound to give as well as the logical inferences follow-
ing the same. In all clinical cases reported we have given the
dilution or potency when given us. If cures have followed
the use of the cruder preparations, to any extent, they have not
been given us, and we have honestly sought for information in
all quarters, sending special invitations through our journals
and by letter. My own case cured by Stannum is perhaps the
best case cured by the lower triturations or dilutions we have.
We certainly fear that disappointment will come to him who
shall from any motive discard the higher attenuations. The ten-
dency of modern science is to the acceptance of the theory of
molecular energy being at the bottom of all transformations
and vital movements. If there be anything clear in the his-
tory of recent investigations in the domain of physics, it is
that Hahnemann was a century in advance of his colleagues
as a thinker and observer. If neural analysis shall show that
his 30th potency actually impresses more rapidly and more
profoundly the nervous system than the 2d, it will certainly
increase our respect for a man whose consummate abilities en-
title him to the first place among physicians.
Acute phthisis, 151
Alumina, 78 to 107
Antimonium crud., 108
Apium vir., 78 to 152
Arsenicum, 156, 160
Arsenicum iod., 109
Auscultation of chest, 54
Auscultation of voice, 63
Baptisia tinct., 160
Bromium, 110, 137
Cactus grand., 91
Calcarea carb., 79, 110 to 113, 161 to 170
Calcarea phos., 171
Carbo veg., 102, 113, 175
Catarrhal phthisis, 103
Causticum, 106, 177
Causes of phthisis, 12
Cinchona off., 92
Clinical, Alumina, 107
" Apium, 155
" Arsenicum, 158 to 160
" Ars. iod., 109
" Bryonia, 130
" Calc. carb., 112, 162 to 170
" Carbo veg., 114, 175
" Causticum, 177
" Ferrum iod., 185
" Iodine, 188
" Kali bichr., 189
" Kali carb., 114, 191
" Kali hydr., 115, 192
" Kali mur, 193
" Lachesis, 194 to 196
Clinical, Lycopodium, 82, 96, 116, 128,
198 to 200
" Magnesia mur., 105
" Mercurius cor., 117
" Mercurius proto. iod., 119
" Mercurius viv., 131, 203
" Myrtus com., 204
" Nitric acid, 120
" Petroleum, 175
" Phosphorus, 127 to 129, 208
" Plumbum acet., 99
" Pulsatilla, 84
" Psorinum, 210
" Sambucus, 212
" Sanguinaria can., 213
" Sepia, 84, 101
" Silicea, 216
" Silphium, 219
" Stannum, 221
Sulphur, 227 to 233
" Tuberculinum, 234 to 236
Conium mac, 79, 114, 180
Contagiousness of phthisis, 27
Contractions of chest, significance of, 44
Disintegration of lung tissue, 36
Drainage, surgical, 149
Early recognition of phthisis, import-
ance of, 86
Elaps cor., 93
Eupatorium per., 182
Exciting causes,. 16
Ferrum,_80, 93, 183
Ferrum iod.. 185
Frequency of phthisis, 73
Function of the lungs, 11
Hemoptysis, 17, 86
Hemoptysis, treatment of, 88
Incipient phthisis apt to be overlooked,
Iodine, 81, 87
Kali bichr., 189
Kali carb., 114, 191
Kali hydr., 114, 192
Kali mur, 193
Lycopodium, 82, 96, 116, 128, 197
Magnesia mur., 105
Mercurius cor., 117, 131
Mercurius proto. iod., 118
Mercurius viv., 131
Mode of administering remedies, 239
Murex purp., 83
Myrtus com., 204
Natrum mur., 205
Nitric ac, 119, 205
Niesser's observations, 238
Percussion, thoracic, 49
Phosphorus, 97, 126, 206
Phosphoric ac, 98
" interstitial, 137
clinical cases reported, 126
Phthisis, acute, 151
" chronic, 152
" a lymphangitis, 23
" bovine, 32
" intestinal complications, 137
Phthisis, pharyngeal, 133
" laryngeal, 134
" syphilitic, 75
Physical diagnosis, 41
Plumbum acet., 99
Prodromic symptoms, 68
Prolonged respiration, 43
Rhus tox., 99
Sambucus nig., 211
Sanguinaria can., 100, 213
Secale cor., 100
Sepia, 84, 101
Stannum, 101, 221
Suggestions for the early management
of phthisis, 70
Sulphur, 127, 228
Swan's, Dr., postulate, 34
Theoretical opinions upon tubercle, 20
Thoracic measurements, 47
" percussion, 49
Treatment of phthisis, errors in, 154
Tubercular degradation but a fragment
of a constitutional malady. 9
Tubercular transformations, 32
Typical chest, 44
Uterine troubles may lead to consump-
Vitality a correlating force, 10
Who are immure, 29
Zincum met., 237
BOERICKE & TAFEL'S
ALLEN, DR. T. F. The Encyclopedia of Pure Materia Medica;
a Record of the Positive Effects of Drugs upon the Healthy
Human Organism. With contributions from Dr. Richard Hughes,
of England; Dr. C. Hering, of Philadelphia; Dr. Carroll Dunham, of
New York; Dr. Adolph Lippe, of Philadelphia, and others. Ten vol-
umes. Price, bound in cloth, $60.00; in half morocco or sheep, $70 00
This is the most complete and extensive work oh Materia Medica ever
attempted in the history of medicine — a work to which the homoeopathic
practitioner may turn with the certainty of finding the whole pathogenetic
record of any remedy ever used in homoeopathy, the record of which being
published either in book form or in journals. The volumes average about
640 pages each.
ALLEN.DR.TF. A General Symptom Register of the Homoe-
opathic Materia Medica. By Timothy F. Allen, M.D., Author of
the Encyclopedia of Pure Materia Medica. 1340 pages in one large
volume. Price, in cloth, $12.00; in sheep or half morocco, $14 00
This Index to the Encyclopedia of Materia Medica is at the same time
the best arranged and most complete Repertory ever attempted. Its inge-
nious selection and arrangement of different kinds of type greatly facilitate
ANGELL, DR. H. C. A Treatise on Diseases of the Eye; for
the Use of Students and Practitioners. By Henry C. Angell,
M.D., Professor of Ophthalmology in the Boston University School of
Medicine, etc., etc. Sixth edition, enlarged and illustrated, nrao.
Cloth, . . . . $3 00
The sixth edition of this standard work has just been issued from the press, and shows
that the whole work has been thoroughly revised and brought up to the latest dates in oph-
thalmology. Exquisite clear photographic illustrations have been added, and an exposition
given of the dioptric or metric system, as applied to lenses for spectacles.
BAEHR, DR. B. The Science of Therapeutics according to the
Principles of Homoeopathy. Translated and enriched with nu-
merous additions from Kafka and other sources, by C. J. Hempel,
M.D. Two volumes. 1387 pages, $9 00
.... "In short Dr. Baehr has presented us with the results of his observations at
the bedside rather than of his researches in the study. It is this which renders his work
valuable, and which at the same time accounts for his occasional imperfections. We know
BOERICKE & TAFELS
of no work of the kind in homoeopathic literature where the suggestions for the choice of
medicines are given in a fresher or clearer manner, or in one better calculated to interest
and inform the practitioner. We have only to add that the two volumes are highly credit-
able to the publishers. The type is good, the paper good, and the binding excellent." —
Monthly Homoeopathic Review.
BELL, DR. JAMES B. The Homoeopathic Therapeutics of
Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera
Infantum, and all other loose evacuations of the bowels.
Second edition by Drs. Bell and Laird. 275 pages. nmo.
Cloth, . ' . i . „ . . . . , |i 50
This little book had a very large sale, and but few physicians' offices will be found with-
out it The work was, without exception, very highly commended by the homoeopathic press.
BERJEAU, J. PH. The Homoeopathic Treatment of Syphilis,
Gonorrhoea, Spermatorrhoea, and Urinary Diseases. Revised,
with numerous additions, by J. H. P. Frost, M.D. 256 pages. i2mo.
Cloth, . . . . . . . . . . $1 50
" This work is unmistakably the production of a practical man. It is short, pithy, and
contains a vast deal of sound, practical instruction. The diseases are briefly described; the
directions for treatment are succinct and summary. It is a book which might with profit
be consulted by all practitioners of homoeopathy." — North American Journal.
BREYFOGLE, DR. W. L. Epitome of Homoeopathic Medi-
cines. 383 pages, $1 25
Interleaved with writing paper. Half morocco, . . . |2 25
We quote from the author's preface :
"It has been my aim, throughout, to arrange in as concise form as possible the leading
symptoms of all well-established provings. To accomplish this, I have compared Lippe's
Mat. Med. ; the Symptomen-Codex ; Jahr's Epitome ; Bcenninghausen's Therapeutic Pocket-
Book, and Hale's New Remedies."
BRYANT, DR. J. A Pocket Manual, or Repertory of Homoeo-
pathic Medicine, Alphabetically and Nosologically arranged, which
may be used as the Physicians' Vade-mecum, the Travellers' Medical
Companion, or the Family Physician. Third edition. 352 pages.
i8mo. Cloth, . . . . . . . . $1 50
BUTLER, DR. JOHN. Electricity in Surgery. Pp.112. Cloth,
These few pages are intended as a practical guide for the use of the specialist and 'general
practitioner, and aim at showing the necessity of attaining accuracy of detail in all electro-
The scope of the work precludes the possibility of more than cursory allusion to clinical
cases, but is based almost entirely upon the author's own personal experience, and is for the
most part composed of articles written from time to time for different periodicals, revised
BUTLER, Dr. JOHN. A Text-Book of Electro-Therapeutics
and Electro-Surgery, for the Use of Students and General
Practitioners. By John Butler, M.D., L.R.C.P.E., L.R.C.S.I.,
etc. Second edition, revised and enlarged. 350 pages. 8vo. Cloth,
" Butler's work gives with exceptional thoroughness all details of the latest researches on
Electricity which powerful agent has a great future, and rightly demands our most earnest
consideration. But Homceopathia especially must hail with delight the advent from out the
ranks of her apostles of a writer of John Butler's ability. His book will also find a large
circle of non-homceopathic readers, since it does not conflict with the tenets of any thera-
peutic sect, and particular care has been bestowed on the technical part of electro-therapeia."
— HOMCEOPATISCHE RUNDSCHAU.
DAKE, DR. WM. C. Pathology and Treatment of Diphtheria.
By Wm. C. Dake, M.D., of Nashville, Tenn. 55 pages. 8vo. Pa-
per, ........... 50 cts.
This interesting monograph was enlarged from a paper read at the Third
Annual Meeting of the Homoeopathic Society of Tennessee, held at Mem-
phis, September 19, 1877.
It gives a report of one hundred and seventy-six cases treated during a
period of eleven months. It well repays a careful perusal.
DUNHAM, CARROLL, A.M., M.D. Homoeopathy the Science
of Therapeutics. A collection of papers elucidating and illustrating
the principles of homoeopathy. 529 pages. 8vo. Cloth, . $3 00
Half morocco, . . . . . . . . $4 00
"After reading this work no one will attempt to justify the practice of alternation of
remedies. It is simply the lazy man's expedient to escape close thinking or to cover his
ignorance. The one remedy alone can be accurate and scientific ; a second or third only
complicates and spoils the case, and will inevitably ruin a good reputation. But to come to
more practical matters, more than one-half of this volume is devoted to a careful analysis of
various drug-pro vings. It teaches us Materia Medica after a new fashion, so that a fool can
understand, not only the full measure of usefulness, but also the limitations which surround
the drug. . . . We ought to give an illustration of his method of analysis, but space
forbids. We can only urge the thoughtful and studious to obtain the book, which they will
esteem as second only to the Organon in its philosophy and learning." — The American
DUNHAM, CARROLL, A.M., M.D. Lectures on Materia Med-
ica. 858 pages. 8vo. Cloth, . . . . . . |j 00
Half morocco, . . . . . . . . . $6 00
. . . "Vol. I is adorned with a most perfect likeness of Dr. Dunham, upon which
stranger and friend will gaze with pleasure. To one skilled in the science of physiognomy
there will be seen the unmistakable impress of the great soul that looked so long and stead-
fastly out of its fair windows. But our readers will be chiefly concerned with the contents
of these two books. They are even better than their embellishments. They are chiefly
such lectures on Materia Medica as Dr. Dunham alone knew how to write. They are pre-
ceded quite naturally by introductory lectures, which he was accustomed to deliver to his
classes on general therapeutics, on rules which should guide us in studying drugs, and on
the therapeutic law. At the close of Vol. II we have several papers of great interest, but
the most important fact of all is that we have here over fifty of our leading remedies pre-
sented in a method which belonged peculiarly to the author, as one of the most successful
teachers our school has yet produced. . . . Blessed will be the library they adorn, and
wise the man or woman into whose mind their light shall shine." — Cincinnati Medical
EATON, DR. MORTON M., on the Medical and Surgical Dis-
eases of Women, with their Homoeopathic Treatment. Fully illus-
trated. Pp. 781. 8vo. Sheep, $6 50
This work is received with great favor by the profession, and is com-
mended by the homoeopathic press as being the best and most complete
work on the subject hitherto issued.
"This is a large, handsome volume of 782 pages, beautifully printed on good paper,
and strongly bound in leather. The illustrations are numerous and good and well bring
out the anatomical relationship of the parts, and put the various dislocations before the mind
very clearly indeed; in fact, almost too clearly, for he who learns thus, and then tries to
carry his knowledge into practice, will feel rather disappointed at the less obliging disposi-
tion of nature herself. Drawings of almost all the principal instruments are given, and the
whole subject brought down to date. There is an air about this work that commends it
very much to our judgment for the use of the student, and of the general practitioner, and
BOERICKE & TAFEL S
hence, we believe, it is destined to become the class-book in homoeopathic colleges for many
years to come. There is a healthy absence of the scissors and paste business. The author
holds the candle of his own experience, and thus affords a reliable aid to the gynaecological
path-finder in all his freshness and inexperience." — From the Homoeopathic World for
EGGERT, DR. W. The Homoeopathic Therapeutics of Uterine
and Vaginal Discharges. 543 pages. 8vo. Half morocco, $3 50
The author brought here together in an admirable and comprehensive
arrangement everything published to date on the subject in the whole homoe-
opathic literature, besides embodying his own abundant personal experience.
The contents, divided into eight parts, are arranged as follows :
Part I. Treats on Menstruation ana Dysmenorrhea; Part II. Menor-
rhagia ; Part III. Amenorrhea; Part IV. Abortion and Miscarriage ; Part
V. Metrorrhagia; Part VI. Fluor albus; Part VII. Lochia; and Part
VIII. General Concomitants. No work as complete as this, on the subject,
was ever before attempted, and we feel assured that it will meet with great
favor by the profession.
"The book is a counterpart of Bell on Diarrhoea, and Dunham on Whooping cough.
Synthetics, Diagnosis and Pathology are left out as not coming within the scope of the work.
The author in his preface says : Remedies and their symptoms are left out, and the symp-
toms and their remedies have received sole attention — that is what the busy practitioner
wants. The work is one of the essentials in a library." — American Observer.
" A most exhaustive treatise, admirably arranged, covering all that is known of thera-
peutics in this important department." — Homoeopathic Times.
GUERNSEY, DR. H. N. The Application of the Principles
and Practice of Homoeopathy to Obstetrics and the Dis-
orders Peculiar to Women and Young Children. By Henry
N. Guernsey, M D., Professor of Obstetrics and Diseases of Women
and Children in the Homoeopathic Medical College of Pennsylvania,
etc., etc. With numerous Illustrations. Third edition, revised, en-
larged, and greatly improved. 1004 pages. 8vo. Half morocco, $8 00
This standard work, with the numerous improvements and additions, is the most com-
plete and comprehensive work on the subject in the English language. Of the previous
editions, almost four thousand copies are in the hands of the profession, and of this third
edition a goodly number have already been taken up. There are few other professional
works that can boast of a like popularity, and with all new improvements and experiences
diligently collected and faithfully incorporated into each successive edition, this favorite
work will retain its hold on the high esteem it is held in by the profession, for years to come.
It is superfluous to add that it was and is used from its first appearance as a text-book at the
GUERNSEY, DR. E. Homoeopathic Domestic Practice. With
Full Descriptions of the Dose to each single Case. Containing also
Chapters on Anatomy, Physiology, Hygiene, and an abridged Materia
Medica. Tenth enlarged, revised, and improved edition. 653 pages.
Half leather, . . . . . . . . . |2 50
GUERNSEY, DR. W. E. The Traveller's Medical Repertory
and Family Adviser for the Homoeopathic Treatment of
Acute Diseases. 36 pages. Cloth, . . . -3° cts -
This little work has been arranged with a view to represent in as compact a manner as
possible all the diseases — or rather disorders — which the non professional would attempt to
prescribe for, it being intended only for the treatment of simple or acute diseases, or to allay
the suffering in maladies of a more serious nature until a homoeopathic practitioner can be
HAHNEMANN, DR. S. The Lesser Writings of. Collected and
Translated by R. E. Dudgeon, M.D. With a Preface and Notes by E.
Marcy, M.D. With a Steel Engraving ot Hahnemann from the statue
of Steinhauser. 784 pages. Half bound, . . . . ^3 00
This valuable work contains a large number of Essays, of great interest to laymen as
well as medical men, upon Diet, the Prevention of Diseases, Ventilation of Dwellings, etc.
As many of these papers were written before the discovery of the homoeopathic theory of
cure, the reader will be enabled to peruse in this volume the ideas of a gigantic intellect
when directed to subjects of general and practical interest.
HAHNEMANN, DR. S. Organon of the Art of Healing. By
Samuel Hahnemann. "Aude Sapere." Fifth American edition, trans-
lated from the Fifth German edition, by C. Wesselhceft, M.D. 244
pages. 8vo. Cloth, . $1 75
This fifth edition of "Hahnemann Organon" has a history. So many
complaints were made again and again of the incorrectness and cumbersome
style of former and existing editions to the publishers, that, yielding to the
pressure, they promised to destroy the plates of the fourth edition, and to
bring out an entire re- translation in 1876, the Centennial year. After due
consideration, and on the warm recommendation of Dr. Constantine Hering
and others, the task of making this re- translation was confided to Dr. C.
Wesselhceft, and the result of years of labor is now before the profession,
who will be best able themselves to judge how well he succeeded in acquit-
ting himself of the difficult task.
"To insure a correct rendition of the text of the author, they (the publishers) selected as
his translator Dr. Conrad Wesselhceft of Boston, an educated physician in every respect,
and from his youth up perfectly familiar with the English and German languages, than
whom no better selection could have been made." "That he has made, as he himself de-
clares, 'an entirely new and independent translation of the whole work,' a careful compari-
son of the various paragraphs, notes, etc., with those contained in previous editions, gives
abundant evidence; and while he has, so far as was possible, adhered strictly to the letter of
Hahnemann's text, he has at the same time given a pleasantly flowing rendition that avoids
the harshness of a strictly literal translation." — Hahnemannian Monthly.
HALE, DR. E. M. Lectures on Diseases of the Heart. In Three
Parts. Part I. Functional Disorders of the Heart. Part II. Inflamma-
tory Affections of the Heart. Part III. Organic Diseases of the Heart.
Second enlarged edition. 248 pages. Cloth, . . ^1 75
HALE, DR. E. M. Materia Medica and Special Therapeutics
of the New Remedies. Fifth edition, revised and enlarged. In
Vol. I. Special Symptomatology. With new Botanical and Pharmaco-
logical Notes and Appendix. 1882. 746 pages. Cloth, . . |j 00
Half morocco, . . . . . . . . . 6 00
Vol. II. Special Therapeutics. With Illustrative Clinical Cases.
900 pages. Cloth, . . . . . ... . , I5 00
Half morocco, . . . . . . . . . |6 00
BOERICKE & TAFEL S
" Dr. Hale's work on ' New Remedies ' is one both well known and much appreciated
on this side of the Atlantic. For many medicines of considerable value we are indebted to
his researches. In the present edition the symptoms produced by the drug investigated and
those which they have been observed to cure, are separated from the clinical observations,
by which the former have been confirmed. That this volume contains a very large amount
of invaluable information is incontestable, and that every effort has been made to secure
both fulness of detail and accuracy of statement, is apparent throughout. For these reasons
we can confidently commend Dr. Hale's fourth edition of his well-known work on the ' New
Remedies' to our homoeopathic colleagues." — Monthly Homceopathic Review.
"We do not hesitate to say that by these publications Dr. Hale rendered an inestimable
service to homoeopathy, and thereby to the art of medicine. ' The school of Hahnemann in
every country owes him hearty thanks for all this ; and allopathy is beginning to share our
gain.' The author is given credit for having in this fourth edition corrected the mistake
for which the third one had been taxed rather severely, by restoring in Vol. II the ' special
therapeutics,' instead of the ' characteristics ' of the third edition." — British Journal of
HALE, DR. E. M. The Medical, Surgical, and Hygienic Treat-
ment of Diseases of Women, especially those causing Ster-
ility, the Disorders and Accidents of Pregnancy, and Pain-
ful and Difficult Labor. By Edwin M. Hale, M.D., Professor of
Materia Medica and Therapeutics in the Chicago Homceopathic College,
etc., etc. Second enlarged edition. 378 pages. 8vo. Cloth, $2 50
'■ This new work embodies the observations and experience of the author during twenty-
five years of active and extensive practice, and is designed to supplement rather than super-
cede kindred works. The arrangement of the subjects treated is methodical and convenient;
the introduction containing an article inserted by permission of Dr. Jackson, of Chicago, the
author upon the ovular and ovulation theory of menstruation, which contains all the obser-
vations of practical importance known on this subject to date. The diseases causing sterility
are fully described, and the medical, surgical and hygienic treatment pointed out. The
more generally employed medicines are enumerated, but their special or specific indications
are unfortunately omitted. The general practitioner will find a great many valuable things
for his daily rounds, and cannot afford to do without the book. The great reputation and
ability of the author are sufficient to recommend the work, and to guarantee an appreciative
reception and large sale." — Hahnemannian Monthly.
HART, DR. C. P. Diseases of the Nervous System. Being a
Treatise on Spasmodic, Paralytic, Neuralgic and Mental Affections.
For the use of Students and Practitioners of Medicine. By Chas. Por-
ter Hart, M.D , Honorary Member of the College of Physicians and
Surgeons of Michigan, etc., etc., etc. Pp. 409. 8vo. Cloth, $3 00
" This work supplies a need keenly felt in our school — a work which will be useful
alike to the general practitioner and specialist; containing, as it does, not only a condensed
compilation of the views of the best authorities on the subject treated, but also the author's
own clinical experience ; to which is appended the appropriate homoeopathic treatment of
each disease. It is written in an easy, flowing style, at the same time there is no waste of
words. ***** We consider the work a highly valuable one, bearing the evidence
of hard work, considerable research and experience." — Medico-Chirurgical Quarterly.
" We feel proud that in Hart's ' Diseases of the Nervous System ' we have a work up to
date, a work which we need not feel ashamed to put in the hands of the neurologist or
alienist for critical examination, a work for which we predict a rapid sale." — North Amer-
ican Journal of Homceopathy.
HELMUTH, DR. W. T. A System of Surgery. Illustrated with
568 Engravings on Wood. By Wm. Tod Helmuth, M.D. Fourth edi-
tion. 1000 pages. Sheep, . . . . . . . $8 50
This edition of Dr. Helmuth's great work is already in appearance a great improve-
ment over the old edition, it being well printed on fine paper, and well bound. By in-
creasing the size of the page, decreasing the size of type, and setting up solid, fully one-half
more printed matter is given than in the previous edition, albeit there are over 200 pages
less; and while the old edition, bound in sheep, was sold at $11.50 by its publishers, this
improved third edition is now furnished at $3 less, or for $8.50. The author brought the
work fully up to date, and for an enumeration of some of the more important improvements,
we cannot do better than to refer to Dr. Helmuth's own Preface.
HEMPEL, DR. C. J., and DR. J. BEAKLEY. Homoeopathic
Theory and Practice. With the Homoeopathic Treatment of Surgi-
cal Diseases, designed for Students and Practitioners of Medicine, and
as a Guide for an intelligent public generally. Fourth edition. 1100
pages, . ■ • 13 00
HERING, DR. C. Condensed Materia Medica. Second edition.
More condensed, revised, enlarged, and improved, . . $7 00
In February, 1877, we were able to announce the completion of Hering's Condensed
Materia Medica. The work, as was to be expected, was bought up with avidity by the pro-
fession and already in the fall of 1878 the author set to work perfecting a second and im-
proved edition. By still more condensing many of the remedies, a number of new ones
could be added without much increasing the size and the price of the work. This new
edition is now ready for the profession, and will be the standard work par excellence for the
practitioner's daily reference.
HEINIGKE, DR. CARL. Pathogenetic Outlines of Homoeo-
pathic Drugs. Translated from the German by Emil Tietze, M.D.,
of Philadelphia. 576 pages. 8vo. Cloth, . . . $3 50
This work, but shortly issued, is already meeting with a large sale and an appreciative
reception. It differs from most works of its class in these respects :
1. That the symptomatic outlines of the various drugs are based exclusively upon the
' pathogenetic" results of provings.
2. That the anatomico-physiological arrangement of the symptoms renders easier the
understanding and survey of the provings.
3. That the pathogenetic pictures drawn of most of the drugs, gives the reader a clearer
idea and a more exact impression of the action of the various remedies.
Each remedy is introduced with a brief account of its preparation, duration of action
HOLCOMBE, DR. W. H. Yellow Fever and its Homoeopathic
Treatment, 10 cts.
HOLCOMBE, DR. W. H. What is Homoeopathy? A new ex-
position of a great truth. 28 pages. 8vo. Paper cover. Per dozen,
#1-25, 15 cts.
" Prove all things, hold fast that which is good." — St. Paul.
HOLCOMBE, DR. W. H. How I became a Homoeopath. 28
pages. 8vo. Paper cover. Per dozen, $1.25, . . . 15 cts.
HOLCOMBE, DR. W. H. Special Report of the Homoeopathic
Yellow Fever Commission, ordered by the American Institute of
Homoeopathy for presentation to Congress. 32 pages. 8vo. Paper.
Per hundred, $4.00, ........ 5 cts.
This Report, written in Dr. Holcombe's masterly manner, is one of the best campaign
documents for homoeopathy. The statistics must convince the most skeptical, and every
homceopathic practitioner should feel in duty bound to aid in securing its widest possible
HOMOEOPATHIC POULTRY PHYSICIAN (Poultry Veteri-
narian) ; or, Plain Directions for the Homoeopathic Treatment of the
BOERICKE & TAFEL'S
most Common Ailments of Fowls, Ducks, Geese, Turkeys and Pigeons,
based on the author's large experience, and compiled from the most re-
liable sources, by Dr. Fr. Schroter. Translated from the German. 84
pages. i2mo. Cloth,. . . . . . . -50 cts.
We imported hundreds of copies of this work in the original German for our customers,
and as it gave good satisfaction, we thought it advisable to give it an English dress, so as to
make it available to the public generally. The little work sells very fast, and our readers
will doubtless often have an opportunity to draw the attention of their patrons to it.
HOMOEOPATHIC COOKERY. Second edition. With Additions
by the Lady of an American Homoeopathic Physician. Designed chiefly
for the Use of such Persons as are under Homoeopathic Treatment. 1 76
pages, 50 cts.
HULL'S JAHR. A New Manual of Homoeopathic Practice.
Edited, with Annotations and Additions, by F. G. Snelling, M.D.
Sixth American edition. With an Appendix of the New Remedies, by
C. J. Hempel, M.D. 2 volumes. 2076 pages, . . $9 00
The first volume, containing the symptomatology, gives the complete pathogenesis of
two hundred and eighty-seven remedies, besides, a large number of new remedies are added
by Dr. Hempel, in the appendix. The second volume contains an admirably arranged Re-
pertory. Each chapter is accompanied by copious clinical remarks and the concomitant
symptoms of the chief remedies for the malady treated of, thus imparting a mass of informa-
tion, rendering the work indispensable to every student and practitioner of medicine.
JAHR, DR. G. H. G. Therapeutic Guide ; the most Important Re-
sults of more than Forty Years' Practice. With Personal Observations
regarding the truly reliable and practically verified Curative Indications
in actual cases of disease. Translated, with Notes and New Remedies,
by C. J. Hempel, M.D. 546 pages, . . . . . I3 00
" With this characteristically long title, the veteran and indefatigable Jahr gives us
another volume of homoeopathies. Besides the explanation of its purport contained in the
title itself, the author's preface still further sets forth its distinctive aim. It is intended, he
says, as a ' guide to beginners, where I only indicate the most important and decisive points
for the selection of a remedy, and where I do not offer anything but what my own individual
experience, during a practice of forty years, has enabled me to verify as absolutely decisive
in choosing the proper remedy. The reader will easily comprehend that, in carrying out
this plan, I had rigidly to exclude all casts concerning which I had no experience of my
own to offer We are bound to say that the book itself is agreeable, chatty, and
full of practical observation. It may be read straight through with interest, and referred to
in the treatment of particular cases with advantage." — British Journal of Homoeopathy.
JAHR, DR. G. H. G. The Homoeopathic Treatment of Dis-
eases of Females and Infants at the Breast. Translated from
the French by C. J. Hempel, M.D. 422 pages. Half leather, $2 00
This work deserves the most careful attention on the part of homoeopathic practitioners.
The diseases to which the female organism is subject are described with the most minute
correctness and the treatment is likewise indicated with a care that would seem to defy
criticism. No one can fail to study this work but with profit and pleasure.
INDEX to the first eighteen volumes of the North American Journal of
Homoeopathy. Paper, . . . . . . . . $2 00
JONES, DR. SAMUEL A. The Grounds of Homoeopathic
Faith. Three Lectures, delivered at the request of Matriculates of the
Department of Medicine and Surgery (Old School) of the University of
Michigan. By Samuel A. Jones, M.D., Professor of Materia Medica,
Therapeutics, and Experimental Pathogenesy in the Homoeopathic
Medical College of the University of Michigan, etc., etc. 92 pages.
i2mo. Cloth. Per dozen, $3.00; per hundred, $20.00, . 30 cts.
Lecture first is on The Law of Similars; its Claim to be a Science in that it
Enables Perversion. Lecture second, The Single Remedy a Necessity of Science.
Lecture third, The Minimum Dose an Inevitable Sequence. A fourth Lecture, on The
Dynamization Theory, was to have finished the course, but was prevented by the approach
of final examinations, the preparation for which left no time lor hearing evening lectures.
The Lectures are issued in a convenient size for the coat-pocket; and as an earnest testi-
mony to the truth, we believe they will find their way into many a homoeopathic household.
JOHNSON, DR. I. D. Therapeutic Key; or, Practical Guide for
the Homoeopathic Treatment of Acute Diseases. Tenth edition. 347
pages. Bound in linen, . . . . . . . $1 75
Bound in flexible cover, . . . . . . . $2 25
This has been one of the best selling works on our shelves; more copies being in circu-
lation of this than of any two other professional works put together. It is safe to say that
there are but few homoeopathic practitioners in this country but have one or more copies of
this little remembrancer in their possession.
JOHNSON, DR. I. D. A Guide to Homoeopathic Practice. De-
signed for the use of Families and Private Individuals. 494 pages.
Cloth, . . . . . . . . . . . $2 00
This is the latest work on Domestic Practice issued, and the well and favorably known
author has surpassed himself. In his book fifty-six remedies are introduced for internal ap-
plication, and four for external use. The work consists of two parts. Part I is subdivided
into seventeen chapters, each being devoted to a special part of the body, or to a peculiar
class of disease. Part II contains a short and concise Materia Medica, i. e.. gives the
symptoms peculiar to each remedy. The whole is carefully written with a view of avoiding
technical terms as much as possible, thus insuring its comprehension by any person of ordi-
nary intelligence. A complete set of remedies in vials holding over fifty doses each, is fur-
nished for $7. or in vials holding over one hundred doses each for $10, or book and case
complete for $9 or $12 respectively. Address orders to Boericke & Tafel's Pharmacies at
New York, Philadelphia, Baltimore, Chicago, New Orleans, or San Francisco.
JOSLIN, DR. B. F. Principles of Homoeopathy. In a Series of
Lectures. 185 pages. i2mo. Cloth, . . . .60 cts.
KREUSSLER, DR. E. The Homoeopathic Treatment of Acute
and Chronic Diseases. Translated from the German, with Im-
portant Additions and Revisions, by C. J. Hempel, M.D. 190
pages, . 60 cts.
The author is a practitioner of great experience and acknowledged talent. This work
is distinguished by concise brevity and lucid simplicity in the description of the various
diseases that usually come under the observation of physicians, and the remedies for the
various symptoms are carefully indicated. Dr. Hempel has interspersed it with a number
of highly useful and interesting notes, which cannot fail to enhance the value of this work
to American physicians.
LAURIE and McCLATCHEY. The Homoeopathic Domestic
Medicine. By Joseph Laurie, M.D. Ninth American, from the
Twenty-first English edition. Edited and Revised, with Numerous and
Important Additions, and the Introduction of the New Remedies. By
R. J. McClatchey, M.D. 1044 pages. 8vo. Half morocco, $5 00
"We do not hesitate to indorse the claims made by the publishers, that this is the most
complete, clear, and comprehensive treatise on the domestic homoeopathic treatment of dis-
10 BOERICKE & TAFEL'S
eases extant. This handsome volume of nearly eleven hundred pages is divided into six
parts. Part one is introductory, and is almost faultless. It gives the most .complete and
exact directions for the maintenance of health, and of the method' of investigating the con-
dition of the sick, and of discriminating between different diseases. It is written in the
most lucid style and is above all things wonderfully free from technicalities. Part two
treats of symptoms character, distinctions, and treatment of general diseases, together with
a chapter on casualties. Part three takes up diseases peculiar to women. Part four
is devoted to the disorders of infancy and childhood. Part five gives the characteristic
symptoms of the medicines referred to in the body of the work, while Part six introduces
the repertory."- — Hahnemannian Monthly.
' Of the usefulness of this work in cases where no educated homoeopathic physician is
within reach, there can be no question. There is no doubt that domestic homoeopathy has
done much to make the science known ; it has also saved lives in emergencies. The prac-
tice has never been so well presented to the public as in this excellent volume." — New
Eng. Med. Gazette.
A complete set of remedies of one hundred and four vials, containing over fifty doses
each, is furnished for $12. put up in an elegant mahogany case. A similar set in vials con-
taining over one hundred doses each, is furnished for $x8 or book and case complete for
$17 or $23 respectively. Address orders to Boericke & Tafel's Pharmacies at New York,
Philadelphia, Baltimore, Chicago, New Orleans', or San Francisco.
LILIENTHAL, DR. S. Homoeopathic Therapeutics. By S.
Lilienthal, M.D., Editor of North American Journal of Homoeo-
pathy, Professor of Clinical Medicine and Psychology in the New York
Homoeopathic Medical College, and Professor of Theory and Practice
in the New York College Hospital for Women, etc. Second edition.
Half morocco, . . . . . . . . . |6 00
" Certainly no one in our ranks is so well qualified for this work as he who has done it,
and in considering the work done, we must have a true conception of the proper sphere of
such a work. For the fresh graduate, this book will be invaluable, and to all such we un-
hesitatingly and very earnestly commend it. To the older one, who says he has no use for
this book, we have nothing to say. He is a good one to avoid when well, and to dread
when ill. We also hope that he is severely an unicum." — Prof. Sam. A. Jones in Ameri-
" . . . It is an extraordinary useful book, and those who add it to their library
will never feel regret, for we are not saying too much in pronouncing it the BEST WORK ON
therapeutics in homoeopathic (or any other) literature. With this under one elbow, and
Hering's or Allen's Materia Meoica under the other, the careful homoeopathic practitioner
can refute Niemayer's too confident assertion, ' I declare it idle to hope for a time when a
medical prescription should be the simple resultant of known quantities.' Doctor, by all
means buy Lilienthal's Homosopathic Therapeutics. It contains a mine of wealth." —
Prof. Chas. Gatchel in Ibid.
LUTZE, DR. A. Manual of Homoeopathic Theory and Prac-
tice. Designed for the use of Physicians and Families.
Translated from the German, with additions by C. J. Hempel, M.D.
From the sixtieth thousand of the German edition. 750 pages. 8vo.
Half leather, . $2 50
This work, from the pen of the late Dr. Lutze, has the largest circulation of any homoeo-
pathic work in Germany, no less than sixty thousand copies having been sold. The intro-
duction, occupying over fifty pages, contains the question of dose, and rules for examining
the patient, and diet; the next sixty pages contain a condensed pathogenesis of the remedies
treated of in the work; the description and treatment of diseases occupy four hundred and
eighteen pages, and the whole concludes with one hundred and seventy-three pages of reper-
tory and a copious index, thus forming a concise and complete work on theory and practice.
MALAN, H. Family Guide to the Administration of Homoeo-
pathic Remedies. 112 pages. 321110. Cloth, . . 30 cts.
HOMOEOPATHIC PUBLICATIONS. 11
MANUAL OF HOMOEOPATHIC VETERINARY PRAC-
TICE. Designed for all kinds of Domestic Animals and Fowls, pre-
scribing their proper treatment when injured or diseased, and their par-
ticular care and general management in health. Second and enlarged
edition. 684 pages. 8vo. Half morocco, . . . I5 00
" In order to rightly estimate the value and comprehensiveness of this great work, the
reader should compare it, as we have done, with the best of those already before the public.
In size, fulness and practical value it is head and shoulders above the very best of them,
while in many most important disorders it is far superior to them altogether, containing, as
it does, recent forms of disease of which they make no mention." — Hahnemannian
MARSDEN, DR. J. H. Handbook of Practical Midwifery, with
full instructions for the Homoeopathic Treatment of the
Diseases of Pregnancy, and the Accidents and Diseases in-
cident to Labor and the Puerperal State. By J. H. Maroden,
A.M.,M.D. 315 pages. Cloth, $2 25
" It is seldom we have perused a text-book with such entire satisfaction as this. The
author has certainly succeeded in his design of furnishing the student and young practitioner,
within as narrow limits as possible, all necessary instruction in practical midwifery. The
work shows on every page extended research and thorough practical knowledge. The style
is clear, the array of facts unique, and the deductions judicious and practical. We are par-
ticularly pleased with his discussion on the management of labor, and the management of
mother and child immediately after the birth, but much is left open to the common-sense
and practical judgment of the attendant in peculiar and individual cases." — Homceopathic
MOHR, DR. CHARLES. The Incompatible Remedies of the
Homoeopathic Materia Medica. By Charles Mohr, M.D., Lec-
turer on Homoeopathic Pharmaceutics, Hahnemann Medical College,
Philadelphia. (A paper read before the Homoeopathic Medical Society
of the County of Philadelphia.) Pamphlet, in cover, . . 10 cts.
This is an interesting paper, which will well repay perusal and study. It gives a list of
fifty-seven remedies and their incompatibles, diligently collated from the best-known sources.
MORGAN, DR. W. The Text-book for Domestic Practice,
being plain and concise directions for the Administration of Homceo-
pathic Medicines in Simple Ailments. 191 pages. 321T10. Cloth, 50 cts.
This is a concise and short treatise on the most common ailments, printed in convenient
size for the pocket; a veritable traveller's companion.
A complete set of thirty remedies, in vials holding over fifty doses each, is furnished for
$4.50, in stout mahogany case; or same set in vials holding over one hundred doses each,
for $6.50; or book and case complete for $5 or $7 respectively. Address orders to Boericke
& Tafel's Pharmacies, New York, Philadelphia, Baltimore, Chicago, New Orleans, or San
MURE, DR. B. Materia Medica; or, Provings of the Principal Ani-
mal and Vegetable Poisons of the Brazilian Empire, and their Applica-
tion in the Treatment of Diseases. Translated from the French, and
arranged according to Hahnemann's Method, by C. J. Hempel, M.D.
220 pages. i2mo. Cloth, . . . . . . . $1 00
This volume, from the pen of the celebrated Dr. Mure, of Rio Janeiro contains the
pathogenesis of thirty-two remedies, a number of which have been used in general practice
ever since the appearance of the work. A faithful wood-cut of the plant or animal treated
of accompanies each pathogenesis.
12 BOERICKE & TAFEL'S
NEIDHARD, DR. C. On the Universality of the Homoeopathic
Law of Cure, . . . 30 cts.
NEW PROVINGS of Cistus Canadensis, Cobaltum, Zingiber and Mer-
curius Proto-Iodatus. 96 pages. Paper, . . . 75 cts.
NORTH AMERICAN JOURNAL OF HOMOEOPATHY. Pub-
lished quarterly on the first days of August, November, February and
May. Edited by S. Lilienthal, M.D. Vol. X, New Series, com-
menced in August, 1879. Subscription price per volume, in advance,
Complete sets of the first twenty-seven volumes, in half morocco bind-
ing, including Index to the first eighteen volumes, . . $90 00
Index to the first eighteen volumes, . . . . $2 00
OEHME, DR. F. G. Therapeutics of Diphtheritis. A Compila-
tion and Critical Review of the German and American Homoeopathic
Literature. Second enlarged edition. 84 pages. Cloth, . 60 cts.
" This pamphlet contains the best compilation of reliable testimony relative to diph-
theria that has appeared from the pen of any member of our school." — Ohio Medical and
" Although he claims nothing more for his book than that it is a compilation, with
' critical reviews,' he has done his work so well and thoroughly as to merit all praise." —
"Dr. Oehme's little book will be worth many times its price to anyone who has to treat
this terrible disease." — British Journal of Homoeopathy.
"It is the best monograph we have yet seen on diphtheria." — Cincinnati Medical
PETERS, DR. J. C. A Complete Treatise on Headaches and
Diseases of the Head. I. The Nature and Treatment of Head-
aches. II. The Nature and Treatment of Apoplexy. III. The Nature
and Treatment of Mental Derangement. IV. The Nature and Treat-
ment of Irritation, Congestion, and Inflammation of the Brain and
its Membranes. Based on Th. J. Riickert' v s Clinical Experiences in
Homoeopathy. 586 pages. Half leather, . . . . $2 50
PETERS, DR. J. C. A Treatise on Apoplexy. With an Appendix
on Softening of the Brain and Paralysis. Based on Th. J. Ruckert's
Clinical Experiences in Homoeopathy. 164 pages. 8vo. Cloth, $1.00
PETERS, DR. J. C. The Diseases of Females and Married
Females. Second edition. Two parts in one volume. 356 pages.
Cloth, $1 50
PETERS, DR. J. C. A Treatise on the Principal Diseases of
the Eyes. Based on Th. J. Ruckert's Clinical Experiences in Ho-
moeopathy. 291 pages. 8vo. Cloth, . . . . . |i 50
PETERS, DR. J. C. A Treatise on the Inflammatory and Or-
ganic Diseases of the Brain. Based on Th. J. Ruckert's Clinical
Experiences in Homoeopathy. 156 pages. 8vo. Cloth, . $1 00
HOMCEOPATHIC PUBLICATIONS. 13
PETERS, DR. J. C. A Treatise on Nervous Derangement and
Mental Disorders. Based on Th. J. Riickert's Clinical Experiences
in Homoeopathy. 104 pages. 8vo. Cloth, . . $1 00
PHYSICIAN'S VISITING LIST AND POCKET REPER-
TORY, THE HOMCEOPATHIC. By Robert Faulkner, M.D.
Second edition, . . , . . . . . , |2 00
" Dr. Faulkner's Visiting List is well adapted to render the details of daily work more
perfectly recorded than any book prepared for the same purpose with which we have hitherto
met. It commences with Almanacs for 1877 and 1878; then follow an obstetric calendar;
a list of Poisons and their Antidotes; an account of Marshall Hall's ready method in As-
phyxia ; a Repertory of between sixty and seventy pages ; pages marked for general memo-
randa; Vaccination Records; Record of Deaths; Nurses; Friends and others; Obstetric
Record, which is especially complete; and finally, pages ruled to keep notes of daily visits,
and also spaces marked for name of the medicine ordered on each day. The plan devised
is so simple, so efficient, and so clear, that we illustrate it on a scale just half the size of the
original (here follows illustration). The list is not divided into special months, but its use
may be as easily commenced in the middle of the year as at the beginning. We heartily
recommend Faulkner's List to our colleagues who may be now making preparations for the
duties of 1878." — Monthly Homoeopathic Review, London.
RAUE, DR. C. G. Special Pathology and Diagnosis, with
Therapeutic Hints. 1072 pages. 8vo. Half morocco. Second
edition, ... . . . . . . . . $7 00
This standard work is used as a textbook in all our colleges, and is found in almost every
physician's library. An especially commendable feature is that it contains the application
of nearly all the new remedies contained in Dr. Hale's work on Materia Medica.
REIL, DR. A. ACONITE, Monograph on, its Therapeutic and
Physiological Effects, together with its Uses and Accurate
Statements, derived from the various Sources of Medical
Literature. By A. Reil, M.D. Translated from the German by
H. B. Millard, M.D. Prize essay. 168 pages, . . .68 cts.
"This Monograph, probably the best which has ever been published upon the subject,
has been translated and given to the public in English, by Dr. Millard, of New York.
Apart from the intrinsic value of the work, which is well-known to all medical German
scholars, the translation of it has been completed in the most thorough and painstaking way ;
and all the Latin and Greek quotations have been carefully rendered into English. The
book itself is a work of great merit, thoroughly exhausting the whole range of the subject.
To obtain a thorough view of the spirit of the action of the drug, we can recommend no
better work." — North American Journal.
RUDDOCK, DR. Principles, Practice, and Progress of Homoe-
opathy. 5 cts. ; per hundred, $3 ; per thousand, . . $25 00
RUSH, DR. JOHN. Veterinary Surgeon. The Handbook to Vet-
erinary Homoeopathy; or, the Homoeopathic Treatment of Horses,
Cattle, Sheep, Dogs, and Swine. From the London edition. With
numerous additions from the Seventh German edition of Dr. F. E.
Gunther's " Homoeopathic Veterinary." Translated by J. F. Sheek,
M.D. 150 pages. i8mo. Cloth, • . . . . -5° cts.
SCHAEFER, J. C. New Manual of Homoeopathic Veterinary
Medicine. An easy and comprehensive arrangement of Diseases,
adapted to the use of every owner of Domestic Animals, and especially
designed for the Farmer living out of the reach of medical advice, and
showing him the way of treating his sick Horses, Cattle, Sheep, Swine>
14 BOERICKE & TAFEL'S
and Dogs, in the most simple, expeditious, safe, and cheap manner.
Translated from the German, with numerous Additions from other
Veterinary Manuals, by C. J. Hempel, M.D. 321 pages. 8vo.
Cloth, . . . . . . . . . . . $2 00
SCHWABE, DR.WILLMAR. Pharmacopoeia Homceopathica
Polyglottica. Second edition. Cloth, . . . . I3 00
SHARP'S TRACTS ON HOMCEOPATHY, each, . . 5 cts.
Per hundred, . . . . . . . . . I3 00
No. I. What is Homoeopathy? No. 7. The Principles of Homoeopathy.
No. 2. The Defence of Homoeopathy. No. 8. Controversy on
No. 3. The Truth of " No. 9. Remedies of
No. 4. The small Doses of " No. 10. Provings of
No. 5. The Difficulties of " No. 11. Single Medicines of
No. 6. Advantages of " No. 12. Common-sense of
SHARP'S TRACTS. Complete set of Twelve Numbers, . 50 cts.
Bound, 75 cts.
SMALL, DR. A. E. Manual of Homoeopathic Practice, for the
use of Families and Private Individuals. Fifteenth enlarged edition.
831 pages. 8vo. Half leather, . . . . . . $2 50
SMALL, DR. A. E. Manual of Homoeopathic Practice. Trans-
lated into German by C. J. Hempel, M.D. Eleventh edition. 643
pages. 8vo. Cloth, . . . . . . . $2 50
SMALL, DR. A. E. Diseases of the Nervous System, to which
is added a Treatise on the Diseases of the Skin, by Dr. C. E. Tooth-
aker. 216 pages. 8vo. Cloth, . . . . . |i 00
This treatise is from the pen of the distinguished author of the well-known and highly
popular work entitled, " Small's Domestic Practice." It contains an elaborate description of
the diseases of the nervous system, together with a full statement of the remedies which have
been used with beneficial effect in the treatment of these disorders.
STAPF, DR. E. Additions to the Materia Medica Pura. Trans-
lated by C. J. Hempel, M.D. 292 pages. v 8vo. Cloth, . $1 50
This work is an indispensable appendix to Hahnemann's Materia Medica Pura. Every
remedy is accompanied with extensive and most interesting clinical remarks, and a variety of
cases illustrative of its therapeutical uses.
VERDI, DR. T. S. Maternity; a Popular Treatise for Young
Wives and Mothers. By Tullio Suzzara Verdi, A.M., M.D., of
Washington, D. C. 450 pages. i2mo. Cloth, . . . |2 00
" No one needs instruction more than a young mother, and the directions given by Dr.
Verdi in this work are such as I should take great pleasure in recommending to all the young
mothers, and some of the old ones, in the range of my practice." — George E. Shipman,
M.D., Chicago, 111.
"Dr. Verdi's book is replete with useful suggestions for wives and mothers, and his
medical instructions for home use accord with the maxims of my best experience in prac-
tice." — John F. Gray, M.D., New York City.
VERDI, DR. T. S. Mothers and Daughters ; Practical Studies for
the Conservation of the Health of Girls. By Tullio Suzzara Verdi,
A.M., M.D. 287 pages. i2mo. Cloth, . . . . $1 50
HOMOEOPATHIC PUBLICATIONS. 15
"The people, and especially the women, need enlightening on many points connected
with their physical life, and the time is fast approaching when it will no longer be thought
singular or ' Yankeeish ' that a woman should be instructed in regard to her sexuality, its or-
gans and their functions. . . . Dr. Verdi is doing a good work in writing such books,
and we trust he will continue in the course he has adopted of educating the mother and
daughters. The book is handsomely presented. It is printed with good type on fine paper,
and is neatly and substantially bound." — Hahnemannian Monthly.
VON TAGEN. Biliary Calculi, Perineorrhaphy, Hospital Gan-
grene, and its Kindred Diseases. i54pages. 8vo. Cloth, $i 25
"Von Tagen was an industrious worker, a close observer, an able writer. The essays
before us bear the marks of this. They are written in an easy, flowing, graceful style, and
are full of valuable suggestions. While the essay on perineorrhaphy is mainly of interest to
the surgeon, the other essays concern the general practitioner. They are exhaustive and
abound in good things. The author is especially emphatic in recommending the use of bro-
mine in the treatment of hospital gangrene, and furnishes striking clinical evidence in sup-
port of his recommendation.
"The book forms a neat volume of 150 pages, and is well worthy of careful study." —
WILLIAMSON, DR. W. Diseases of Females and Children,
and their Homoeopathic Treatment. Third enlarged edition.
256 pages. i2mo. Cloth, . . . . . . $1 00
This work contains a short treatise on the homoeopathic treatment of the diseases of fe-
males and children, the conduct to be observed during pregnancy, labor, and confinement,
and directions for the management of new-born infants.
WINSLOW, DR. W. H. The Human Ear and Its Diseases.
A Practical Treatise upon the Examination, Recognition, and Treat-
ment of Affections of the Ear and Associate Parts, Prepared for the In-
struction of Students and the Guidance of Physicians. By W. H. Win-
slow, M.D., Ph.D., Oculist and Aurist to the Pittsburg Homoeopathic
Hospital, etc., etc., with one hundred and thirty-eight illustrations.
Boericke & Tafel : New York and Philadelphia. Pp. 526. 8vo.
Cloth, $4 50
"... We hail with pleasure the advent of this work. There is perhaps no branch
in the science of medicine in which there has been so little advance as in that of otology.
Our author has treated his subject very systematically, giving first the anatomy, then the
physiology, as at present understood, methods of examination, morbid changes and injuries,
and finally the therapeutics. This last is of especial value to us, as our provings are singu-
larly deficient in reference to symptoms of the ear. . . . This book is a move in the
right direction, and we earnestly hope it will prove a stimulus for other specialists of our
school." — New England Medical Gazette.
"... Moreover, he has literally crammed the work with thoughts and suggestions
of a practical kind, such as could only be the outgrowth of a large personal experience and
long-continued habits of close and careful observation. . . . The work is thoroughly
practical throughout; theories are left iu the background, and the hard facts of the business
of the otologist are portrayed with a distinctness and force which characterize all the writings
of this author. — Hahnemannian Monthly.
WORCESTER, DR. S. Repertory to the Modalities. In their
Relations to Temperature, Air, Water, Winds, Weather and
Seasons. Based mainly upon Hering's Condensed Materia Medica,
with additions from Allen, Lippe, and Hale. Compiled and arranged
by Samuel Worcester, M.D, Salem, Mass., Lecturer on Insanity and
its Jurisprudence at Boston University School of Medicine, etc., etc.
1880. 160 pages. i2mo. Cloth, . . . . . $1 25
16 BOERICKE & TAFEL'S HOMOEOPATHIC .PUBLICATIONS.
" This ' Repertory to the Modalities ' is indeed a most useful undertaking, and will,
without question, be a material aid to rapid and sound prescribing where there are promi-
nent modalities. The first chapter treats of the sun and its effects, both beneficial and hurt-
ful, and we see at a glance that Strontium carb., Anacardium, Conium mac, and Kali bich.
are likely to be useful to patients who like basking in the sun. No doubt many of these
modalities are more or less fanciful ; still a great many of them are real and of vast clinical
" The book is nicely printed, on good paper, and strongly bound. It contains only 160
pages. We predict that it will meet with a steady, long-continued sale, and in the course of
lime be found on the tables of most of those careful and conscientious prescribers who admit
the philosophical value of (for instance) lunar aggravations, effects of thunder-storms, etc.
And who, being without the priggishness of mere brute science, does not?" — Homoeo-
"WORCESTER, DR. S. Insanity and Its Treatment. Lectures
on the Treatment of Insanity and Kindred Nervous Diseases. By
Samuel Worcester, M.D., Salem, Mass. Lecturer on Insanity, Ner-
vous Diseases and Dermatology, at Boston University School of Medi-
cine, etc., etc., . . . . . . . . . $3 50
Dr. Worcester was for a number of years assistant physician of the Butler
Hospital for the Insane, at Providence, R. I., and was appointed shortly
after as Lecturer on Insanity and Nervous Diseases to the Boston University
School of Medicine. The work, comprising nearly five hundred pages, will
be welcomed by every homoeopathic practitioner, for every physician is called
upon sooner or later to undertake the treatment of cases of insanity among
his patrons' families, inasmuch as very many are loth to deliver any afflicted
member to a public institution without having first exhausted all means within
their power to effect a cure, and the family physician naturally is the first to
be put in charge of the case. It is, therefore, of paramount importance that
every homoeopathic practitioner's library should contain such an indispensa-
" The basis of Dr. Worcester's work was a course of lectures delivered before the senior
students of the Boston University School of Medicine. As now presented with some altera-
tions and additions, it makes a very excellent text-book for students and practitioners. Dr.
Worcester has drawn very largely upon standard authorities and his own experience, which
has not been small. In the direction of homoeopathic treatment, he has received valuable
assistance from Drs. Talcott and Butler, of the New York State Insane Asylum. It is not,
nor does it pretend to be, an exhaustive work ; but as a well-digested summary of our present
knowledge of insanity, we feel sure that it will give satisfaction. We cordially recommend
it." — New England Medical Gazette.
THE AMERICAN HOMOEOPATHIC PHARMACOPOEIA.
Compiled and Published by Boericke & Tafel. Pp. 523, 8vo. Cloth, $3.50.
No physician, busy or otherwise, can afford to neglecft a correct knowledge of the forms
and preparations of his armament against disease. This knowledge is as necessary in con-
trolling legitimate operations on part of the pharmacist, as in preparing remedies individually.
In point of general information and especially of minute and unmistakable directions, the
work stands alone among the recent publications on this subject. Special attention is given
to synonyms in the body of the book, besides being fully represented in a large and copious
S@" All the Medicines mentioned in this work can be obtained in
their utmost purity and conscientiously prepared at
BQERICKE k TAFEL'S
EST^IBILISIIIEID I INT 1835.
NEW YORK, 145 Grand St.
PHILADELPHIA, 101 lAreh St.
PHILADELPHIA, 1216 Girard Ave.
BALTIMORE, 135 West Fayette -St.
NEW ORLEANS, 130 Canal St.
CHICAGO, 35 South Clark St.
SAN- FRANCISCO, 234 Sutter St.
NOTICE TO PHYSICIANS.
Mother Tinctures. In the preparation of our Mother Tinctures, we make
use of none but fresh, green plants, for the proper collection of which we have un-
usual facilities. Most of these are collected by ourselves within a radius of less
than twenty miles from Philadelphia. Plants indigenous to the West we procure
through our branch in Chicago ; those of the South, through our branch in New
Orleans ; while plants growing on the Pacific Coast, the Sandwich Islands, etc.,
are furnished by our branch at San Francisco. Thus saturated tinctures made
from fresh plants, gathered when in full vigor, may at all times be relied upon.
European Homoeopathic Tinctures we import from the best known sources,
i. e., from reputable Homoeopathic Pharmacies.
The only exceptions to above rule are tinctures from plants growing in distant
countries, as Nux vom., Rheum, Ignatia, etc., which of necessity are made from
carefully selected dry material.
Triturations. Our Triturations are made with Pure Sugar of Milk in steam
triturators with the latest improvements. Having ample facilities, we are enabled
to accord to each trituration fully two hours, whereby an unusual degree of excel-
lence is obtained. Remedies such as Sepia, Mercurius v., Graphites, are triturated
four hours or longer, until the desired grade of comminution is secured.
Dilutions. Our Dilutions are all conscientiously made by hand. We com-
menced by running up one hundred remedies to the 30th, retaining all intermediate
attenuations and using a separate box for each remedy. Gradually the list has in-
creased until to-day we carry in stock over seven hundred remedies, and are able to
supply any of them like the 12th, 15th, 24th, etc., as readily as the 3d or 6th. Each
of our eight pharmacies carries such a set in stock, and our patrons thus have ab-
solute surety of obtaining any intermediate potency called for.
Our Pharmacies are devoted exclusively to the sale of Homoeopathic Medi-
cines and Books; and as all Branch Establishments are supplied from our Labora-
tory in Philadelphia, Medicines of our uniform standard quality, may be obtained
alike from either of our establishments.
In conclusion, we beg to assure the profession that, it has ever been our en-
deavor to excel in the quality of our preparations ; that while furnishing our medi-
cines at a moderate advance on cost, we do not intend to compete with establish-
ments whose sole claims lie in cheap prices. Our endeavors have met with hearty
acknowledgement by the profession, and the generous support accorded to our es-
tablishments, bears witness to our ability to give satisfaction to our many patrons.
Complete Price List and Illustrated Catalogue sent free to Physi-
cians on application.
Date betted £>w.